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Retinal Artery Macroaneurysm – November, 2024

History:

A 75-year-old woman was referred for macular edema in the left eye (OS). She reported blurry vision with metamorphopsia OS for 2-3 months.

Exam:

Visual acuity (VA) was 20/25 in the right eye (OD) and 20/70 OS. Intraocular pressures were normal in both eyes (OU). Anterior segment exam was remarkable for pseudophakia OU. Dilated fundus exam OD was unremarkable. Dilated fundus exam OS revealed normal optic nerve, trace vitreous hemorrhage inferiorly, mild arterial attenuation, and a retinal artery macroaneurysm along the inferior arcade with mild macular edema and epiretinal membrane (Figure 1 and 2).

Focal laser photocoagulation of the macroaneurysm was performed (Figure 3). Three weeks following treatment, VA remained 20/70. Eleven weeks following laser, VA improved to 20/40 and macular edema continue to improve (Figure 4).

Differential Diagnosis:

• Retinal Artery Macroaneurysm
• Diabetic Retinopathy
• Retinal Vein Occlusion
• Radiation Retinopathy

Discussion:

Retinal Artery Macroaneurysm

Retinal artery macroaneurysm (RAM) is typically a unilateral and isolated condition that can result in subretinal, retinal, preretinal, or vitreous hemorrhage in addition to retinal edema or lipid exudation. One third of cases can be associated with retinal venous obstruction and 10% may be bilateral.

RAM is more common in elderly patients and has a strong association with chronic systemic hypertension and arteriosclerosis. Focal ischemia of the blood vessel wall may cause increased vessel permeability and remodeling leading to aneurysmal dilation and susceptibility to rupture.

Most RAMs can be observed as lesions may spontaneously resolve and involute. Treatment is considered when secondary edema or exudation threaten the macula.

Primary treatment is typically laser photocoagulation to the aneurysm and surrounding retina. Observation studies have shown improvement in exudation and macular edema with anti-VEGF intravitreal injections. YAG laser hyaloidotomy has also been used to dissolve trapped preretinal hemorrhage into the vitreous.

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References:

1. Singh D, Tripathy K. Retinal Macroaneurysm. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.