Purpose
To report three cases of early-onset macular hole secondary to a ruptured retinal arterial macroaneurysm.
Results
The patients were diagnosed with a subretinal hemorrhage with macular involvement. A macular hole was confirmed during the
first fundus examination in two cases, and after vitreous surgery to remove a sub-internal limiting membrane (ILM) hemorrhage
overlying the macula in the third case. All cases were probably complicated with a macular hole immediately after the rupture
of a macroaneurysm. The distance from the macroaneurysm to the fovea was 2250 µm or less. All cases had a submacular hemorrhage
and retinal detachment around the macular hole. In cases 2 and 3, vitrectomy with peeling of the ILM and SF6 gas tamponade
led to closure of the macular hole; the macular hole remained open in case 1 without vitrectomy. Independent of anatomic repair
of macular holes, the final best-corrected visual acuity (VA) was less than 20/67 in all cases.
Conclusions
Early-onset macular hole formation secondary to a ruptured retinal arterial macroaneurysm occurs mechanically due to the proximity
between the macroaneurysm and the fovea. Current and previous reports have suggested that any VA improvement was likely to
be limited, at least in older patients.
Keywords Macular hole - Retinal arterial macroaneurysm - Subretinal hemorrhage - Visual acuity - Vitrectomy