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Abstract
Purpose
To report a case of a recurrent macular hemorrhage that developed after surgical removal of the internal limiting membrane (ILM) for subintimal hemorrhage due to retinal macroaneurysm.
Case Summary
A 75-year-old female was admitted to the hospital complaining of decreased vision in the left eye which had started 3 weeks previously. The best corrected visual acuity (BCVA) of the right and left eye was 0.7 and 0.03, respectively. The intraocular pressure (IOP) of the right and left eye was 10 mm Hg and 12 mm Hg, respectively. On the fundus examination, macular preretinal and subretinal hemorrhage was observed and a diagnosis of retinal arterial macro-aneurym of the inferonasal major artery was made. Vitrectomy was performed. After indocyanine green dye staining, the sub-ILM hemorrhage was treated with removal of the ILM. At postoperative day 3, the annular chorioretinal folds were observed due to the hypotony (4 mm Hg). However, the absence of leakage was confirmed through the sclerotomy site. At postoperative day 8, recurrent submacular hemorrhage occurred and the hemorrhage was observed to have spread after intravitreal C3 F8 gas injection and when the patient was placed in the prone position. At postoperative 4 months, the hemorrhage that had invaded the macular area was completely resolved. The BCVA was 0.3, respectively.
References
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Figure 1.
(A) Subretinal hemorrhage and preretinal hemorrhage are visible in the macular area. There is a macroaneurysm on the in-ferotemporal branch of the retinal artery (arrow). (B) Fluorescein angiography shows blocked fluorescence in the macular area due to subretinal and preretinal hemorrhage. There is hyperfluorescence that corresponds to a retinal arterial macroaneurysm (yellow arrow).
Figure 3.
(A) The internal limiting membrane (ILM) is peeled with ICG dye staining (white arrow). The sub-ILM hemorrhage and macroaneurysm are visible (yellow arrow). (B) The sub-ILM hemorrhage is removed (white arrow), the subretinal hemorrhage and macroaneurysm are visible.
Figure 4.
Fundus photographs (3 days after vitrectomy) (A) The subretinal hemorrhage remains in the perimacular area. (B) Chorioretinal folds are visible in the supratemporal area (arrow).
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