Under pressure: Foveal mountain peak sign and macular hole after ruptured RAM.
I A Domínguez-Varela, M A López-Montoy, G E Enriquez-Vera
✦ AI-curated · Sources linked
Case in brief
A patient presented with submacular hemorrhage from a ruptured retinal arterial macroaneurysm (RAM). The hemorrhagic clot initially obscured the macula, but two weeks later examination showed a 340 μm full-thickness macular hole (MH). Pneumatic displacement with sulfur hexafluoride was performed to reduce hemorrhagic toxicity and potentially encourage closure. At three months, the MH remained open and visual acuity was 20/150.
What made this case unusual
The hemorrhage concealed the MH at initial examination; the foveal mountain peak sign was identified as a predictive indicator of subsequent MH formation.
Diagnostic / clinical pearl
After submacular hemorrhage from a ruptured RAM, an MH may be hidden by the clot and become apparent later. The foveal mountain peak sign may help predict its development.
Why it matters
The report notes that persistent MH and visual impairment are concerns, particularly when the RAM rupture is close to the fovea (<1500 μm), and states that early surgical intervention should be considered.