J Korean Ophthalmol Soc.  2011 Apr;52(4):487-491.

The Recurrent Submacular Hemorrhage after Removal of Sub-Internal Limiting Membrane Hemorrhage with Retinal Arterial Macroaneurysm

• Kim JY
• Heo DW
• Jo YJ

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 macroaneurym 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 C3F8 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.
CONCLUSIONS
When removing a sub-ILM hemorrhage due to retinal macroaneurysm, recurrent hemorrhage can occur especially in a patient with ocular hypotony, as in the present case report. Physicians should be aware of this possibility and the proper treatment the condition requires.

Keyword

Hypotony; Indocyanine green dye staining; Recurrent submacular hemorrhage; Retinal arterial macroaneurysm; Sub-Internal limiting membrane hemorrhage

MeSH Terms

Aged
Arteries
Eye
Female
Hemorrhage
Humans
Indocyanine Green
Intraocular Pressure
Membranes
Ocular Hypotension
Prone Position
Retinaldehyde
Vision, Ocular
Visual Acuity
Vitrectomy
Indocyanine Green
Retinaldehyde

Figure

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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).

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  Figure 2. The hemorrhage remains after induction of posterior vitreous detachment.

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  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.

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  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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  Figure 5. The recurrent submacular hemorrhage had developed. After gas injection submacular hemorrhage was dispersed (arrow) (13 days after vitrectomy and 5 days after gas injection).

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  Figure 6. Fundus photographs (4 months after recurrent hemorrhage). The submacular hemorrhage had disappeared, and the macroaneurysm became whitish fibrosis (arrow).

Reference

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