Atlas of Ophthalmology

Retinal Arterial Macroaneurysm RAMA (Colour Photography Posterior Segment, FFA, SD-OCT)

Retina -> Vascular Diseases (see also: Systemic Immunologic Diseases)
Patient: 63 years of age, male, BCVA 0.5. General Medical History: diabetes, arterial hypertension. Ocular Medical History: loss of visual acuity at OS. Purpose: to present a retinal lesion, suggesting retinal macroaneurysma by FFA. Methods: Colour Photography Posterior Segment, Fluorescein Angiography, SD-OCT. Findings: Colour Photography Posterior Segment: greyish-white lesion located close to the temporal upper retinal artery, intraretinal exudation, as a possible cause of visual deterioration. Fluorescein Angiography: slow filling, no retinal vein occlusion. SD-OCT: circumferential dilation of the vessel wall, visible exsudates. Discussion: Retinal arterial macroaneurysm (RAMA) is an acquired vessel dilation of branches of the central retinal artery. Risk factors include female gender, age over 60 years and arterial hypertension. The typical course of a RAMA starts with a growing phase, followed by gradual spontaneous fibrosis and/or thrombosis and finally involution without any therapy. In exudative RAMA, laser photocoagulation is an established therapy to induce thrombosis and promote reabsorption of exudates. Antiangiogenic intravitreal therapy has proven effective to close the RAMA and improve vision. Koinzer et al (1) examined N=49 charts of patients with RAMA and compared the long-term visual acuity (VA) in three groups according to treatment: untreated, photocoagulation and vitrectomy. He found that VA remained unchanged in the observed and the laser groups after 3 years. Literature: (1) Koinzer S, Heckmann J, Tode J, Roider J. Long-term, therapy-related visual outcome of 49 cases with retinal arterial macroaneurysm: a case series and literature review. ) Br J Ophthalmol. 2015 Apr 16. pii: bjophthalmol-2014-305884.

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