Clinical Results of Vitrectomy in Macular Hemorrhage From a Ruptured Retinal Artery Macroaneurysm

Dong Hyun Kim; Hyeong Gon Yu

doi:10.3341/jkos.2010.51.7.961

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Kim and Yu: Clinical Results of Vitrectomy in Macular Hemorrhage From a Ruptured Retinal Artery Macroaneurysm

Original Article

J Korean Ophthalmol Soc 2010;51(7):961-966.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.961

Clinical Results of Vitrectomy in Macular Hemorrhage From a Ruptured Retinal Artery Macroaneurysm

Dong Hyun Kim, MD¹, Hyeong Gon Yu, MD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Sensory organ research institute, Medical Research Center, Seoul National University, Seoul, Korea

Address reprint requests to Hyeong Gon Yu, MD, Department of Ophthalmology, Seoul National University Hospital #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: hgonyu@snu.ac.kr

Received 11 September 2009 Accepted 4 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the relationship between postoperative optical coherence tomography (OCT) findings and visual acuity in patients who underwent vitrectomy for macular hemorrhage related to the rupture of a retinal artery macroaneurysm.

Methods

A retrospective case review was conducted for patients who underwent vitrectomy for macular hemorrhage caused by a retinal arterial macroaneurysm. The relationship between postoperative OCT findings and visual acuity was analyzed.

Results

This study included 12 patients whose preoperative mean best corrected visual acuity (BCVA) (logMAR) was 1.7±0.8 and whose mean final BCVA was 0.6±0.5. These values were statistically different (p=0.004). Mean foveal thickness by OCT was 437.5±161.5 μ m at the preoperative period and 252.8±84.9 μ m three months postoperative, and this difference was statisti-cally significant (p=0.017). As the foveal thickness decreased after removal of the remnant organized retinal hemorrhage in the postoperative period, BCVA improved at the final follow-up (p=0.048). According to the postoperative OCT, the photoreceptor disruption group presented a lower BCVA than that of the photoreceptor preservation group at the final follow-up (logMAR: 1.4±0.4 vs. 0.3±0.2, p=0.009).

Conclusions

Photoreceptor preservation as observed by OCT was significantly associated with better visual outcome after vitrectomy in patients with macular hemorrhage caused by rupture of a retinal arterial macroaneurysm.

Keywords: Retinal artery macroaneurysm, Macular hemorrhage, Vitrectomy, Optical coherence tomography, Prognosis of visual acuity

References

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Figure 1.

Optical coherence tomography (OCT) and fundus findings in patient in which postoperative photoreceptor is intact (Yellow arrows: photoreceptor IS-OS junction) (No. 7).

Figure 2.

OCT and fundus findings in patient in which postoperative photoreceptor is disruptive (Yellow arrows: photoreceptor IS-OS junction) (No. 10).

Table 1.

Patient characteristics

No.	Sex	Age	HTN t	Symptom to surgery interval (weeks)	Location (distance from optic disc)	Fundus finding	Visual acuity			OCT
No.	Sex	Age	HTN t	Symptom to surgery interval (weeks)	Location (distance from optic disc)	Fundus finding	Preop BCVA	Postop 1-2 week UCVA	Final BCVA	Postoperative photoreceptor disruption	F/U (months)
1	F	79	+	12	ST (1DD),	VH/PRH/	LS+	0.1	0.3	(−)	44
					SN (2DD)	IRH/SRH
2	F	67	+	4	ST (1DD)	VH/PRH/	0.02	HM	0.02	(+)	27
						IRH/SRH
3	F	49	+	12	IT (2DD)	PRH/IRH/	0.04	0.08	0.5	(−)	37
SRH
4	M	54	−	9	IT (2DD)	PRH/IRH/	0.04	FC	0.7	(−)	25
SRH
5	M	65	−	9	IT (2DD)	VH/PRH/	LS+	0.4	1.0	(−)	28
IRH
6	F	62	−	11	ST (2DD)	PRH/IRH/	FC	FC	0.1	(+)	29
SRH
7	F	74	+	4	ST (2DD)	PRH/IRH/	0.15	0.15	0.9	(−)	27
SRH
8	M	74	−	1	ST (2DD)	VH/PRH/	HM	0.1	0.6	(−)	7
IRH/SRH
9	F	79	+	8	IT (2DD)	IRH	HM	0.3	0.3	(−)	6
10	F	72	+	19	ST (2DD)	VH/PRH/	HM	FC	0.04	(+)	18
IRH/SRH
11	F	78	+	5	ST (2DD)	PRH/IRH	FC	0.15	0.3	(−)	3
12	F	79	+	4	IT (2DD)	PRH/IRH/	0.02	0.15	0.3	(−)	3
SRH

Table 2.

Comparison of preoperative and postoperative best corrected visual acuities (BCVA) and foveal thickness

	Preop (n=12)	Postop	P-value^*
BCVA (logMAR)	1.7±0.8	0.6±0.5^†	0.004
Foveal thickness (μm)	437.5±161.5	252.8±84.9^‡	0.017

^* Wilcoxon test

^† Final BCVA

^‡ OCT in postoperative 3 months.

Table 3.

Comparison of final best corrected visual acuities (BCVA) between intact and disruptive photoreceptor group

	Intact photoreceptor (n=9)	Disruptive photoreceptor (n=3)	P-value
Final BCVA (logMAR)	0.3±0.2	1.4±0.4	0.009^*

^* Mann-Whitney U test.

Table 4.

Comparison of final best corrected visual acuities (BCVA) between large and small macular hemorrhage group

Macular Hemorrhage size	Large (≥5 DD) (n=6)	Small (<5 DD)(n=6)	P value
Final BCVA (logMAR)	0.4±0.6	0.9±0.8	0.303^*

^* Mann-Whitney U test.

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