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Jan Heckmann, Stefan O. Koinzer, Jost Hillenkamp, Johann Roider; Visual Outcome Of Early Vitrectomy And Gas Tamponade In The Management Of Ruptured Retinal Arterial Macroaneurysm. Invest. Ophthalmol. Vis. Sci. 2012;53(14):978.
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Retinal arterial macroaneurysm (RAMA) may cause vision loss due to hemorrhagic macular complications. Macular hemorrhage occurs sub-internal limiting membrane (ILM), intra- or subretinally
Single center retrospective chart review from 2008 to 2011. 14 eyes of 14 consecutive patients with macular hemorrhage due to ruptured RAMA were treated with vitrectomy and gas tamponade for sub-ILM, intra- or subretinal macular hemorrhage. Vitrectomy with ILM peeling was performed in 8 of 14 eyes and recombinant tissue plasminogen activator (rtPA) was injected intravitreally in 2 of 14 eyes and subretinally in 5 of 14 eyes. Duration of symptoms, pre- and postoperative best corrected logMAR visual acuity (BCVA) and complications were recorded
Vitrectomy was performed within 3.1±4.0 days [mean, standard deviation (SD)] after onset of symptoms. Preoperative BCVA was 1.6±0.8, light perception to 0.4 (mean, SD, range). 7 of 14 eyes had additional intravitreal hemorrhage and 9 of 14 eyes additional subhyaloid hemorrhage. Macular hemorrhage was successfully displaced in 10 of 14 eyes. 2 macular holes were found intraoperatively. Postoperatively, subretinal hemorrhage recurred in one eye and retinal detachments occurred in 3 eyes. Follow up was 16±24, 2 to 95 months (mean, SD, range). BCVA at last follow-up was 0.9±1.1, light perception to 0 (mean, SD, range) while 8 of 14 eyes achieved reading ability (BCVA 0.4 or better).
Vitrectomy is an effective treatment of ruptured RAMA with macular hemorrhage with satisfactory outcome in most eyes. Secondary macular hole caused by subretinal hemorrhage and postoperative retinal detachment may limit final function.
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