Abstract:ABSTRACT.Background: Acquired retinal macroaneurysms are round dilatations of retinal arterioles that occur in the posterior fundus. They tend to rupture before they grow large and cause a visual decrease. The average diameter of macroaneurysms in the previous reports is 281 micrometer. Methods: A 63-year-old man complained of a sudden decrease of visual acuity in the left eye. Fundus examination of his left eye revealed a large protruded mass, 2 disc diameters in size, at the first bifurcation of the inferote… Show more
“…5 Moreover, ICG angiography showed incomplete filling of the aneurysmal dilatation, suggesting that autothrombosis had occurred. In the present case, ICG angiography distinctly demonstrated the inflow of the ICG dye from the retinal artery into the mass, with pulsation, and helped to differentiate it from a mass lesion such as granuloma or capillary hemangioma.…”
“…5 Moreover, ICG angiography showed incomplete filling of the aneurysmal dilatation, suggesting that autothrombosis had occurred. In the present case, ICG angiography distinctly demonstrated the inflow of the ICG dye from the retinal artery into the mass, with pulsation, and helped to differentiate it from a mass lesion such as granuloma or capillary hemangioma.…”
“…However, the present retinal arterial macroaneurysm was about 2-disc-diameters in size. One case of a large retinal arterial macroaneurysm at the first bifurcation has been reported [ 5 ]; however, there are no reports of a large retinal arterial macroaneurysm on the optic disc. Intraoperatively, the hematoma was red, not pulsatile, and appeared to be filled with coagulants.…”
Section: Discussionmentioning
confidence: 99%
“…All the preoperative clinical information we had was the B-mode ultrasonographic image shown in Figure 1 . Retinal arterial macroaneurysms usually undergo spontaneous involution [ 5 , 6 , 9 , 10 ]. To the best of our knowledge, a case of dense vitreous hemorrhage that was associated with a rupture of an arterial macroaneurysm on the optic disc has not been reported yet.…”
We report a novel case of vitreous hemorrhage associated with suspected rupture of 2-disc-diameter retinal arterial macroaneurysm on the optic disc. A 90-year-old woman presented with blurred vision (sudden onset) in her left eye. Examination of the fundus revealed acute onset vitreous hemorrhage of unknown origin without retinal detachment. She underwent vitrectomy, but after excision of the dense vitreous hemorrhage, a 2-disc-diameter hematoma appeared on the optic disc and was removed promptly. Because the bleeding at the base of the hematoma was of arterial origin and pulsating, the first vitrectomy could not achieve hemostasis. Five days after the first surgery, we performed a second vitrectomy. This revealed a subretinal hemorrhage along the superior and inferior arcade vessels and a macular hole, which was almost completely closed with an inverted internal limiting membrane flap. Unfortunately, the macular hole reopened 41 days after the second surgery. In patients presenting with only a large hematoma on the optic disc, it might be prudent to leave the hematoma. However, this large retinal arterial macroaneurysm was on a rare location on the optic disc, making it doubly difficult for the surgeons to diagnose and choose the best option intraoperatively. The differential diagnosis for dense vitreous hemorrhage of unknown origin should include a large retinal arterial macroaneurysm on the optic disc.
“…Retinal arterial macroaneurysms (RAMs) were identified as early as the 1900s. They were first formally described by Robertson in 1973 as a large, fusiform or round dilation of the retinal arterioles occurring in the posterior pole within the first three orders of the retinal artery tree . He identified them as a unique pathology given their natural tendency for spontaneous fibrosis along with the accompanying exudation and association with longstanding hypertension .…”
Retinal macroaneurysms are an acquired vascular anomaly primarily associated with advancing age and hypertension. Although a rare pathology, it is not uncommon for a patient with a macroaneurysm to present to the primary care optometrist. Macroaneurysms have various presentations and they constitute one of the few clinical entities that can produce preretinal, intraretinal, subretinal or vitreal haemorrhage or any combination thereof. A review of the pathophysiology, differential diagnosis and newest treatments will be provided.A 68-year-old Caucasian male patient with a history of a previously treated retinal macroaneurysm presented to the eye clinic with acute-onset visual loss in the same eye. The patient had a known diagnosis of hypertension and had been untreated by his primary care physician for one year. Dilated fundus examination revealed extensive multi-layered haemorrhaging along with significant macular oedema. A choroidal neovascular membrane was ruled out with fluorescein angiography. The patient was treated with monthly bevacizumab injections over a period of three months. At six months optical coherence tomography confirmed the resolution of macular oedema and the patient achieved a marked improvement in his visual acuity.Retinal arterial macroaneurysm is one of the few clinical entities with the potential to produce any combination of preretinal, intraretinal, subretinal and/or vitreal haemorrhage. When the macula is threatened, treatment must be pursued. Although laser treatment has traditionally been used, anti-vascular endothelial growth factor therapy has been used with promising visual outcomes.
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