Internal Limiting Membrane Peeling and Dexamethasone Intravitreal Implant for the Management of a Retinal Macroaneurysm Rupture

Abstract Background: To describe an effective combined surgical and pharmacological approach for the management of a sub-internal limiting membrane (sub-ILM) macular hemorrhage and exudation related to a retinal arterial macroaneurysm (RAM) decompensation.Methods: Pars plana vitrectomy (PPV) was performed, with an accurate forceps-assisted ILM removal, hemorrhage aspiration, and a dexamethasone intravitreal implant injection at the end of the surgery. Anatomical and functional outcomes were evaluated by fundus examination, spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCT-A) and best-corrected visual acuity (BCVA). Results: Postoperative outcome revealed that sub-ILM blood was successfully cleaned, and the RAM became progressively thrombosed with complete resolution of the exudation. Three months after surgery, BCVA improved from 20/400 to 20/80 with no signs of recurrence.Conclusion: This combined surgical and pharmacological approach could be an effective technique for the management of sub-ILM hemorrhage secondary to RAM decompensation, and favors anatomical macular restoration and significant recovery of the visual acuity.