Atlas of Ophthalmology

Female, 81 years of age, BCVA 0.3 at OD, 0.6 at OS, Major complaints: deterioration of BCVA at OD since two months. Ocular medical history: beginning cataract. General medical history: arterial hypertension, history of cardiac infarction. Purpose: To describe the morphologic changes of a retinal macroaneurysm. Methods: Patient underwent ophthalmoscopy, FFA, and Heidelberg spectral-domain optical coherence tomography (OCT) Findings: Ophthalmoscopy: subretinal hemorrhage, retinal exudate FFA: lack of early hyperfluorescence, focal hypofluorescence due to retinal hemorrhage. OCT: superficial retinal hemorrhage, intraretinal lipids, and minor intraretinal edema prominently involving the outer retinal layers. Discussion: Arterial macroaneurysms comprise a distinct retinal vascular disorder. Most commonly seen in elderly females, the disorder is often associated with underlying hypertension and systemic arteriosclerotic disease. The natural history is one of gradual and spontaneous involution with good visual prognosis in the majority of cases. Complications of retinal or vitreous hemorrhage and macular edema, with resultant loss of vision, can occur. Treatment is recommended when there is visual loss. Photocoagulation treatment may be applied directly to the macroaneurysm, indirectly by surrounding the macroaneurysm, or as a combination of these two methods. It remains unclear whether indirect treatment is superior to direct treatment (1). Literature: (1) Rabb MF, Gagliano DA, Teske MP. Retinal arterial macroaneurysms. Surv Ophthalmol. 1988 Sep-Oct;33(2):73-96.

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