Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

Abstract

Objective: To report a case of recurrent vitreous hemorrhage from an optic nerve retinal arterial macroaneurysm (ONRAM) successfully treated with intraoperative endolaser. Patient and Methods: A 92-year-old woman on oral aspirin and warfarin anticoagulation for atrial fibrillation developed three episodes of dense vitreous hemorrhage from an ONRAM. Due to failure of the vitreous hemorrhage to clear spontaneously, a total of three pars plana vitrectomy (PPV) procedures were performed along with a 1.25-mg intravitreal bevacizumab injection after the third episode of hemorrhage. During the third PPV procedure, a 25-gauge 532-nm green diode laser endoprobe was used to deliver low-power (100 mW) and long-duration (500 ms) laser spots directly on the ONRAM to induce intraoperative shrinkage of the ONRAM. Results: After the endolaser treatment, the macroaneurysm showed involution due to fibrosis without any adverse effects on retinal circulation or visual field defect. No recurrence of vitreous hemorrhage was noted after 2 years of follow-up. Conclusion: Oral anticoagulant use may have been responsible for the atypical clinical course in our patient. Laser photocoagulation, including intraoperative endolaser photocoagulation, may be considered in selected cases of symptomatic ONRAMs.

Acute Onset of Dense Vitreous Hemorrhage Associated with Retinal Arterial Macroaneurysm on the Optic Disc

“…Treatment of RAMs is only required in symptomatic and complicated cases. Although some cases reported that laser photocoagulation for RAM on the optic disc was effective in symptomatic cases [ 11 , 13 ], the risk of visual field loss by this method should not be neglected. In this case, we did not observe any pulsation of the RAM or blood oozing from it intraoperatively, and the macula was intact.…”

“…RAMs on the optic disc generally disappear without any intervention [ 6 , 14 , 15 ]. Although recurrent VH was not observed in this case, cases receiving oral anticoagulants should be monitored for the possibility of recurrence [ 6 , 11 ].…”

“…In this case, FA image 1 month after surgery showed normal retinal circulation. Ruptured RAM on the optic disc in approximately 25% of patients could cause BRAO [ 4 , 7 , 11 ]. Therefore, we need to have longer follow-up to determine whether BRAO will develop in the future.…”

“…Most common complications of RAM on the optic disc include retinal hemorrhages, retinal exudates, branch retinal artery occlusion (BRAO), and vitreous hemorrhages (VH) [ 1 , 2 , 3 , 4 , 5 ]. Although RAMs can cause VH [ 1 , 2 , 3 , 5 ], their frequency and timing of VH occurrence on the optic disc is unknown [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. To the best of our knowledge, no reports have clearly demonstrated the early onset of VH after development of RAM on the optic disc.…”

Multimodal Imaging of a Thrombosed Optic Disk Macroaneurysm

“…1–3 Treatment with laser photocoagulation or vascular endothelial growth factor inhibitors is controversial, and it is reserved for persistent symptomatic cases. 4,5 The present photo essay exemplifies the typical evolution of these lesions through a multimodal approach.…”