Treatment of macular hemorrhage in retinal arterial microaneurysm: anatomic site-oriented therapy.

PURPOSE: To investigate the usefulness of anatomic site-oriented therapy for macular hemorrhage secondary to retinal arterial macroaneurysm (RAM). STUDY DESIGN: Retrospective observational study, clinical case series METHODS: Twenty-seven consecutive patients (27 eyes) with macular hemorrhage secondary to RAM were classified according to the retinal layer(s) with hemorrhage identified by optical coherence tomography into 4 types and treated differentially. Vitrectomy was conducted for subinternal limiting membrane hemorrhage (SILMH), intravitreal gas injection for subretinal hemorrhage (SRH) or intraretinal hemorrhage (IRH), and vitrectomy and intravitreal air/gas exchange for multilevel hemorrhage (at least 2 among SILMH/SRH/IRH). RESULTS: Complete displacement or resolution of the macular hemorrhage was achieved in all 27 eyes: 7 with SILMH, 7 with SRH, 3 with IRH, and 10 with multilevel hemorrhage. Compared with the baseline score, the 3-month postoperative Early Treatment Diabetic Retinopathy Study score (mean ± SD) improved significantly in SILMH (+42.9 ± 6.9 letters; P < .0001, paired t test), multilevel hemorrhage (+23.9 ± 14.4 letters; P = .0005), and SRH (+17.7 ± 18.4 letters; P = .0440), but not in IRH (+6.7 ± 9.0 letters; P = .3228). Compared with the baseline thickness, the 3-month postoperative central retinal thickness decreased significantly in multilevel hemorrhage (-930.3 ± 290.8 µm; P < .0001), SILMH (-628.4 ± 177.0 µm; P < .0001), IRH (-508.3 ± 72.1 µm; P = .0066), and SRH (-476.9 ± 300.0 µm; P = .0056). The central ellipsoid zone was detectable in 7/7 eyes with SILMH but in none of the eyes in the other 3 groups (P < .0001). No retinal detachment or macular hole occurred in any eyes. CONCLUSION: For macular hemorrhage secondary to RAM, anatomic site-oriented therapy using different treatments targeting the hemorrhagic retinal layers is useful. The optimal treatments for individual hemorrhagic retinal layers require further studies.

Foveal Avascular Zone Area Analysis in Macular Hole Before and After Surgery Using Optical Coherence Tomography Angiography.

BACKGROUND AND OBJECTIVE: To analyze the foveal avascular zone (FAZ) area in superficial and deep retinal layers in patients with macular hole (MH) before and after surgery. PATIENTS AND METHODS: The authors studied 14 patients with unilateral MH. They examined a 3 mm × 3 mm area at the fovea before and 6 months after surgery using spectral-domain optical coherence tomography angiography. RESULTS: In eyes affected by MH, the mean preoperative superficial FAZ (0.45 ± 0.09 mm2) and deep FAZ (0.79 ± 0.39 mm2) were significantly larger than the postoperative superficial FAZ (0.25 ± 0.09 mm2) and deep FAZ (0.31 ± 0.12 mm2), respectively (P < .001). The mean preoperative superficial FAZ of the affected eyes was the same as that of control eyes (0.41 ± 0.10 mm2) (P = .23), but postoperative superficial FAZ was smaller than that of control eyes (P < .001). The mean preoperative deep FAZ was larger (0.48 ± 0.11 mm2) (P = .019), but mean postoperative deep FAZ was smaller than that of control eyes (P < .001). CONCLUSIONS: The authors revealed preoperative deep FAZ areas were more enlarged centrifugally than preoperative superficial FAZ in MH. Both postoperative superficial and deep FAZ showed more centripetal contraction than those of the preoperative period. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:329-335.].