September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Sub-inner limiting membrane macular hemorrhages: diagnosis, etiologies, management and outcome
Author Affiliations & Notes
  • Joël Gambrelle
    Ophthalmology, Clinique Pasteur Lanroze, Brest, France
  • Melanie Bressollette-Frappier
    Novartis France, Rueil Malmaison, France
  • Anne Robinet
    Ophthalmology, Clinique Pasteur Lanroze, Brest, France
  • Footnotes
    Commercial Relationships   Joël Gambrelle, None; Melanie Bressollette-Frappier, Novartis (E); Anne Robinet, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2033. doi:
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    • Get Citation

      Joël Gambrelle, Melanie Bressollette-Frappier, Anne Robinet; Sub-inner limiting membrane macular hemorrhages: diagnosis, etiologies, management and outcome. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2033.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : The inner limiting membrane (ILM) is a cell-free membrane on the surface of the retina on which are inserted the fibers of the posterior hyaloïd. Sub-ILM macular hemorrhages (SILMMH) are uncommon and should be differentiated from subhyaloid macular hemorrhages (SHMH) because of their different etiologies.

Methods : A retrospective analysis of 11 consecutive cases of SILMMH identified in a french clinical setting was performed: clinical and spectral domain optical coherence tomography (SD-OCT) findings, etiologies, management and outcomes of these cases were described.

Results : 11 cases were analyzed: 8 were females and mean age was 55 years [24y - 83y]. All patients have been referred with sudden visual impairment (Best corrected visual acuity (BCVA) was limited to 20/2000 or less in 9 cases) and premacular hemorrhage. All patients underwent a SD-OCT which confirm the diagnosis of SILMMH. SILMMH was isolated (3 cases) or combined with vitreous hemorrhages (1 case), with SHMH (1 case), with intraretinal hemorrhages (7 cases) or with sub-retinal hemorrhage (1 case). In 5 cases, posterior vitreous detachment was present at diagnosis. Etiologies of SILMMH were a rupture of a retinal macro-aneurysm (4 cases), a Vasalva maneuver (2 cases), a Terson’s syndrome (2 cases), a severe anemia (1 case), a retinal vein occlusion (1 case) and a laser injury (1 case). In 6 cases the management of SILMMH consisted in simple monitoring. In one of them, spontaneous resorption of the SILMMH revealed a full thickness macular hole. The SILMMH related to retinal vein occlusion has been treated by ranibizumab intravitreal injections due to its combination with a macular edema. The 4 SILMMH related to the rupture of a retinal macro-aneurysm have been treated by early pars plana vitrectomy combined with ILM peeling, hemorrhage aspiration and endolaser photocoagulation of the macro-aneurysm. Procedure-related retinal detachment occured in one case. After 6 months of follow-up and complete resorption of hemorrhage, BCVA was superior to 20/40 for 9/11 patients.

Conclusions : Despite an almost identical clinical presentation SILMMH and SHMH have usually distinct pathophysiological origins: unlike the SHMH is usually due to bleeding from a pre-retinal neovessel consecutive to retinal ischemia, causes of SILMMH seems rather bleeding from retinal vessels themselves. Most of the SILMMH showed good anatomic and functional outcomes.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


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