SUB-INTERNAL LIMITING MEMBRANE FOVEAL HEMORRHAGE UNDER TENSION: Optical Coherence Tomography Biomarkers Predicting Macular Hole Formation After Submacular Hemorrhage.

Abstract

To identify preoperative clinical characteristics of macular hole (MH) formation after vitrectomy for submacular hemorrhage because of ruptured retinal arterial macroaneurysm. The authors retrospectively analyzed eyes with submacular hemorrhage because of a ruptured retinal arterial macroaneurysm in patients who underwent vitrectomy and had more than 1 month of follow-up. Background factors and imaging findings were compared between groups classified by MH presence. The primary outcomes were best-corrected visual acuity, and fundus and optical coherence tomography findings. Submacular hemorrhage because of a retinal arterial macroaneurysm rupture was identified in 48 eyes. Macular holes were identified in 8 eyes (16.3%): four intraoperatively and four postoperatively. Preoperative optical coherence tomography findings revealed that all MH cases exhibited the highest retinal thickness at the foveal lesion with sub-internal limiting membrane hemorrhage preoperatively. This finding was termed the "foveal mountain peak" sign, characterized by sub-internal limiting membrane hemorrhage where the peak of the retinal thickness coincides with the fovea. The incidence of foveal mountain peak sign (+) cases was significantly higher in the MH (+) group compared with the MH (-) group (100% vs. 47.5%, respectively; P = 0.006). The presence of the foveal mountain peak sign may indicate an increased risk of submacular hemorrhage-associated MH.