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Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 2/2019

01-03-2019 | Vitrectomy | Clinical Investigation

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

Authors: Yorihisa Kitagawa, Akiyo Kawamorita, Hiroyuki Shimada, Hiroyuki Nakashizuka

Published in: Japanese Journal of Ophthalmology | Issue 2/2019

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Abstract

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.
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Metadata
Title
Treatment of macular hemorrhage in retinal arterial microaneurysm: anatomic site-oriented therapy
Authors
Yorihisa Kitagawa
Akiyo Kawamorita
Hiroyuki Shimada
Hiroyuki Nakashizuka
Publication date
01-03-2019
Publisher
Springer Japan
Keyword
Vitrectomy
Published in
Japanese Journal of Ophthalmology / Issue 2/2019
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-019-00653-y

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