case_images: PMC7452955_01
case_images: a) The clinical photograph of the right eye demonstrates the presence of a full-thickness macular hole and massive multilevel retinal hemorrhage secondary to a ruptured retinal arterial macroaneurysm in the superotemporal arcade area. b) The fluorescein angiography study confirms the presence of a retinal arterial macroaneurysm in the superior temporal arcade. c) and d) show optical coherence tomography scans with 3-D reconstruction confirming the macular hole 600 microm in diameter.
case_images: OC-10-31-g-001.jpg
case_images: PMC7452955_01_OC-10-31-g-001.jpg
case_images: F1
case_images: As shown in Figure 1 (Fig. 1), her fundus examination revealed intraretinal and massive subretinal hemorrhage with macular involvement. The patient's optical coherence tomography (OCT) confirmed the presence of a full-thickness MH and subretinal hyperreflective materials due to subretinal hemorrhage (Figure 1 (Fig. 1)).
case_images: Surgical steps: a) Macular hole, submacular hemorrhage, and arterial macroaneurysm are present; b) ILM peeling; c) rtPA injection using vitrectomy probe via the macular hole, and extension of the submacular hemorrhage area after injection of rtPA; d) Fluid-air exchange at the end of the surgery
case_images: OC-10-31-g-002.jpg
case_images: PMC7452955_01_OC-10-31-g-002.jpg
case_images: F2
case_images: The surgery was followed by fluid-air exchange and the injection of a nonexpansile concentration of sulfur hexafluoride (SF6, Eyesun Teb Co, Tehran, Iran) (Figure 2 (Fig. 2)).
case_images: a) The clinical photograph taken 1 month after the initial presentation shows resolution of the subretinal hemorrhage with remained pigmentary changes and anatomical closure of the macular hole. b) OCT scan 1 week after surgery shows restoration of the external limiting membrane. c) OCT scan 1 month after the surgery shows that the ellipsoid zone is also recovering.
case_images: OC-10-31-g-003.jpg
case_images: PMC7452955_01_OC-10-31-g-003.jpg
case_images: F3
case_images: OCT images confirmed the complete anatomical closure of the MH and restoration of the outer retinal layers such as the external limiting membrane and the ellipsoid zone (Figure 3 (Fig. 3)).