Arterial Macroaneurysm with Macular Hole Post Surgery

These are the color fundus photograph and SD-OCT of an 80 year-old woman who presented in October 2013 with a ruptured macroaneurysm. Frame A shows the fundus photograph and SD-OCT upon presentation. The yellow arrows indicate a premacular and submacular clot, which decreased vision to counting fingers at one foot. The white arrow shows the blocking effect of the premacular hemorrhage on the SD-OCT. Vitrectomy with injection of subretinal tissue plasminogen activator and exchange of 20 percent sulfur hexafluoride gas for vitreous fluid was performed later that week. Frame B, shows photos from 1 month follow up. The green arrow shows a dispersing submacular clot, following the surgery. The blue arrow shows the early formation of a macular hole. This is more clearly seen in the SD-OCT image (fuchsia arrow). Frame C shows the appearance at 4 months after surgery with a full thickness macular hole (white arrow) and retinal pigment epithelial changes (black arrow).The macular hole is seen with SD-OCT (yellow arrow). It is possible that injection of subretinal tissue plasminogen activator may predispose to macular hole formation, but it has not been shown to be the case.