PURPOSE: To investigate the risk factors of macular hole (MH) in patients with retinal arterial macroaneurysm (RAM) rupture. DESIGN: Retrospective observational cohort study. PARTICIPANTS: We reviewed the records of patients with RAM rupture who underwent pars plana vitrectomy (PPV) at Hyogo Prefectural Amagasaki General Medical Center between December 2015 and December 2024. We included consecutive cases with sub-internal limiting membrane (sub-ILM) hemorrhage covering the fovea and with unclear macular hole (MH) status on optical coherence tomography (OCT) before surgery. METHODS: The following data were extracted from the medical records: age, sex, duration between onset and first examination or surgery, axial length, preoperative best-corrected visual acuity (BCVA), systemic hypertension and diabetes mellitus, oral administration of antiplatelets and anticoagulants, RAM location (superior or inferior to the fovea), distance from the RAM to the fovea, presence of a niveau (fluid level) in sub-ILM hemorrhage, fluffy sign, foveal mountain peak (FMP) sign, and type of surgical procedure (vitrectomy system 25/27 gauge, combined cataract surgery, subretinal tissue plasminogen activator t-PA injection, and sulfur hexafluoride gas tamponade). MAIN OUTCOME MEASURES: The presence of MH in patients with RAM rupture. RESULTS: Thirty-nine patients were included in this study. MH was observed in 14 patients (35.9%). Fluid level in sub-ILM hemorrhage was observed in 92.0% and 14.3% of the patients without and with MH, respectively. The absence of fluid level was associated with the presence of MH (p < 0.01). Subretinal injection of t-PA was more frequently administered to patients with MH (p = 0.027). However, multivariate logistic regression analysis revealed that only fluid level in sub-ILM hemorrhage was significantly associated with MH development (p < 0.01; risk ratio = 0.0033; 95% confidence interval = -12.1 to -2.6). CONCLUSIONS: The absence of fluid level in sub-ILM hemorrhage was associated with MH development. Fluid level in sub-ILM hemorrhage is a useful predictive factor of MH in patients with RAM rupture.
Otsuka et al. (Tue,) studied this question.