23-Gauge PPV With ILM Peel for Fovea-Involving Sub-ILM Hemorrhage Due to Retinal Arterial Macroaneurysm

An 80-year-old woman presented with acute vision loss in her right eye due to a retinal arterial macroaneurysm. Because she had a large fovea-involving sub-internal limiting membrane (ILM) hemorrhage precluding a clear view of the subfoveal space, she elected for vitrectomy with ILM peel with the possibility of subretinal tissue plasminogen activator (tPA) injection if subfoveal hemorrhage was found.

Once the ILM peel was performed, the fovea was found to be clear and subretinal tPA was not needed. The patient did well with SF6 gas and face-down positioning.