COMPARISON OF FOVEA-SPARING (BUTTON-HOLE) AND CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING IN RETINAL ARTERIAL MACROANEURYSM RUPTURE: Visual and Anatomical Outcomes.

Both surgical groups showed significant improvement in best-corrected visual acuity following vitrectomy for retinal arterial macroaneurysm rupture.

• Group 1 (conventional ILM peeling) improved from 20 to 55 ETDRS letters (P < 0.001).
• Group 2 (foveal-sparing/button-hole ILM peeling) improved from 25 to 65 ETDRS letters (P < 0.001).
• The study included 42 eyes from 42 patients who underwent vitrectomy between September 2016 and December 2023.
• All patients presented with sub-ILM hemorrhage and subretinal hemorrhage accompanying retinal arterial macroaneurysm rupture.

Postoperative best-corrected visual acuity was significantly better in the foveal-sparing (button-hole) ILM peeling group compared to the conventional ILM peeling group.

• Group 2 (button-hole, n = 20) achieved a final BCVA of 65 ETDRS letters versus 55 ETDRS letters in Group 1 (conventional, n = 22).
• The difference in postoperative BCVA between groups was statistically significant (P = 0.039).
• This was a retrospective review with subgroup analyses performed based on macular hole presence or absence detected preoperatively or intraoperatively.

Postoperative macular hole formation occurred significantly more frequently in the conventional ILM peeling group than in the foveal-sparing group.

• Macular hole formation occurred in 22.7% of eyes in Group 1 (conventional ILM peeling).
• No macular hole formation occurred in Group 2 (foveal-sparing/button-hole ILM peeling, 0%).
• The difference in macular hole incidence between groups was statistically significant (P = 0.049).

Subgroup analysis confirmed consistent benefits of the button-hole technique even after adjusting for baseline differences.

• Subgroup analyses were performed based on macular hole presence or absence detected preoperatively or intraoperatively.
• The benefit of the button-hole technique remained statistically significant after adjustment for baseline differences (P = 0.034).