COMPARISON OF FOVEA-SPARING (BUTTON-HOLE) AND CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING IN RETINAL ARTERIAL MACROANEURYSM RUPTURE

PURPOSE: To compare surgical outcomes of foveal-sparing internal limiting membrane (ILM) peeling (button-hole) with conventional ILM peeling in patients with retinal arterial macroaneurysm rupture accompanied by sub-ILM hemorrhage (sub-ILMh) and subretinal hemorrhage, focusing on visual and anatomical results and postoperative macular hole formation. METHODS: A retrospective review was conducted on 42 eyes (42 patients) who underwent vitrectomy for retinal arterial macroaneurysm rupture with sub-ILMh and subretinal hemorrhage between September 2016 and December 2023. Patients were divided into two groups: conventional ILM peeling (Group 1, n = 22) and foveal-sparing ILM peeling (button-hole) (Group 2, n = 20). Subgroup analyses were performed based on macular hole presence or absence detected preoperatively or intraoperatively. RESULTS: Both groups showed significant improvement in best-corrected visual acuity, with Group 1 improving from 20 to 55 ETDRS letters and Group 2 from 25 to 65 ETDRS letters (P < 0.001). Postoperative best-corrected visual acuity was significantly better in Group 2 (P = 0.039). Macular hole formation occurred in 22.7% eyes of Group 1 but not in Group 2 (P = 0.049). Subgroup analysis showed consistent benefits of the button-hole technique even after adjusting for baseline differences (P = 0.034). CONCLUSION: Foveal-sparing ILM peeling (button-hole) has superior visual and anatomical outcomes than conventional ILM peeling, reducing postoperative macular hole incidence in patients with retinal arterial macroaneurysm rupture.