Early-onset macular holes following ruptured retinal arterial macroaneurysms.

PURPOSE: To report three cases of early-onset macular hole secondary to a ruptured retinal arterial macroaneurysm.

METHODS: Case reports.

RESULTS: The patients were diagnosed with a subretinal hemorrhage with macular involvement. A macular hole was confirmed during the first fundus examination in two cases, and after vitreous surgery to remove a sub-internal limiting membrane (ILM) hemorrhage overlying the macula in the third case. All cases were probably complicated with a macular hole immediately after the rupture of a macroaneurysm. The distance from the macroaneurysm to the fovea was 2250 microm or less. All cases had a submacular hemorrhage and retinal detachment around the macular hole. In cases 2 and 3, vitrectomy with peeling of the ILM and SF6 gas tamponade led to closure of the macular hole; the macular hole remained open in case 1 without vitrectomy. Independent of anatomic repair of macular holes, the final best-corrected visual acuity (VA) was less than 20/67 in all cases.

CONCLUSIONS: Early-onset macular hole formation secondary to a ruptured retinal arterial macroaneurysm occurs mechanically due to the proximity between the macroaneurysm and the fovea. Current and previous reports have suggested that any VA improvement was likely to be limited, at least in older patients.