Ruptured retinal arterial macroaneurysm: Diagnosis and management

Abstract

Retinal arterial macroaneurysm is an acquired, focal dilation of a retinal artery, typically occurring within the first three bifurcations of the central retinal artery. The clinical presentation of a retinal arterial macroaneurysm is highly variable, making initial diagnosis difficult and differentials many. Identification of retinal arterial macroaneurysms is crucial to appropriately co-manage with the primary care physician for hypertension control. Prognosis is generally good and observation is often an adequate treatment. However, in cases of macular threat or involvement, some treatment options are available and referral to a retinal specialist is indicated.

Intravitreal ranibizumab or conbercept for retinal arterial macroaneurysm: a case series

“…Anti-VEGF agents may cause vasoconstriction and reduce nitrogen oxide production, which provide a beneficial role in the resolution of macular edema. Besides, these agents may improve the balance between coagulation and fibrinolysis, which facilitates the dissipation of macular hemorrhage [8, 11, 14, 16, 17]. In our paper, case 1 and case 2 received intravitreal ranibizumab injections and still achieved satisfactory anatomical and visual results at the one-year follow-up.…”

“…RAMs are rare, acquired, localized dilation of retinal arterial branches, possibly resulting in macular edema, serous retinal detachment with subretinal fluid, and intraretinal lipid accumulation [11]. The abrupt rupture of RAMs may cause subretinal, intraretinal, preretinal or vitreous hemorrhage.…”

“…Thus, early intervention is recommended, especially in cases with foveal involvement. The most common treatment is direct argon laser photocoagulation at the site of RAM, but with several complications, such as possible retinal traction, an increase in retinal exudation, and enlargement of the laser scar, which limit the use in the clinical practice to some extent [11, 12]. Other therapeutic options include pneumatic displacement of tissue by a plasminogen activator, surgical removal of the associated hemorrhage with vitrectomy, and photodisruption of the internal limiting membrane or the posterior hyaloid to release the hemorrhage [11].…”

Retinal Arterial Macroaneurysms: Updating Your Memory on RAM Management

“…This may not only possibly expedite improvement of vision, but may also facilitate assessing the extent of maculopathy. [22] Submacular hemorrhage can damage photoreceptors with the result that eyes affected by such hemorrhage generally have poor visual outcomes if left untreated. [23] The thrombolytic properties of tissue plasminogen activator (tPA) can be used to assist in overall treatment.…”

“…[24][25][26][27][28][29] Vitrectomy, however, is not without risk, with possible resulting complications that may include cataract formation, retinal break or detachment, active bleeding, macular hole, and endophthalmitis. [22] During pneumatic displacement, perfluorocarbon gas is injected into the eye to physically displace the macular hemorrhage. Patents are then instructed to lie prone for at least a week to assist such displacement.…”