Vitreous Hemorrhage Caused by Ruptured Retinal Macroaneurysm

Asao, Kazunobu; Nakada, Atsuko; Kawasaki, Yoichi

doi:10.1159/000358796

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…1 Several studies have shown that PPV is an effective treatment method to address more complicated, severe cases of RAM with VH. 1,15 In our study, the mean ± SD time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. One hypothesis is that PPV is more often recommended for moderate to severe cases with the need for a sooner return of higher level of visual acuity or prompter need to clear an obscuring VH to properly monitor the RAM in subsequent months.…”

Section: Discussionmentioning

confidence: 59%

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Lam,

Shahlaee,

Salabati

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To evaluate the clinical outcomes of different types of treatment of retinal arterial macroaneurysm with vitreous hemorrhage. Methods: This retrospective cohort study comprised patients with retinal arterial macroaneurysm and vitreous hemorrhage who were examined at a single retina clinic between 2013 and 2021. Results: Treatment arms included observation (n = 33), intravitreal injections (IVI) of antivascular endothelial growth factor agents (n = 5), and pars plana vitrectomy (PPV; n = 12). Baseline characteristics and final best-corrected visual acuity (BCVA) were similar in a combined analysis of all treatment groups ( P > .05). BCVA improved in all eyes, but the IVI and PPV arms had worse presenting BCVA. The mean number of injections was 3.6 ± 2.8. The incidence of subretinal hemorrhage was 18.2% in the observation arm, 25.0% in the PPV group (8.3% had subretinal tissue plasminogen activator), and 60.0% in the IVI group. The mean time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. There was no correlation between the number of injections and final BCVA ( r = 0.13, P = .830). The IVI and PPV arms were more frequently on anticoagulants ( P = .011). There was no difference in final BCVA between those using anticoagulants (0.52 ± 0.53) vs not using anticoagulants (0.55 ± 0.65; P = .870). Conclusions: Most patients, regardless of treatment modality, demonstrated significantly improved BCVA and similar final visual outcomes. Patients with worse presenting BCVA were more likely to undergo PPV or IVI whereas those with better presenting BCVA had excellent outcomes with observation alone. Improved BCVA was not associated with the number of IVIs or anticoagulant use.

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Section: Discussionmentioning

confidence: 59%

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Lam,

Shahlaee,

Salabati

et al. 2023

Journal of VitreoRetinal Diseases

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“…These vessels are subsequently more susceptible to dilation from elevated hydrostatic pressure . When the aneurysmal dehiscence is large, it is more likely to lead to haemorrhages at all levels of the retina . Hypertensive patients are more prone to these occurrences as they experience increased hydrostatic pressure, decreased autoregulation and hyaline degeneration …”

Section: Discussionmentioning

confidence: 99%

“…In patients presenting with retinal haemorrhage and exudation, the clinician must rule out diabetic retinopathy, retinal vein occlusion, Coats' disease, radiation retinopathy, cavernous haemangioma and retinal capillary haemangiomas. Differentials for when vitreous haemorrhage is present include proliferative diabetic retinopathy, ischaemic retinal vein occlusion, retinal tear and wet age‐related macular degeneration . In these cases, the diagnosis may be complicated as the aneurysm may be obscured by blood in the vitreous.…”

Section: Discussionmentioning

confidence: 99%

Multi‐layered haemorrhage secondary to retinal arterial macroaneurysm: A case report and review

Aumiller

Rinehart

2015

Clinical and Experimental Optometry

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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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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Sasajima¹,

Zako²,

Aoyagi³

et al. 2022

Case Rep Ophthalmol

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We present a rare case of acute onset of dense vitreous hemorrhage (VH) associated with ruptured retinal arterial macroaneurysm (RAM) on the optic disc. A 63-year-old Japanese man had undergone phacoemulsification combined with pars plana vitrectomy (PPV) including internal limiting membrane peeling in the right eye for a macular hole approximately 1 year before presentation. His decimal best-corrected visual acuity (BCVA) in the right eye was stable at 0.8 with no recurrence of macular hole. He visited our hospital emergently prior to his regular postoperative visit for a sudden decrease in visual acuity in the right eye. Clinical examinations and imaging tests revealed dense VH in the right eye, and we could not observe the fundus. B-mode ultrasonography of the right eye showed dense VH without retinal detachment and a bulge on the optic disc. His BCVA decreased to hand movement in the right eye. He had no medical history of hypertension, diabetes, dyslipidemia, antithrombotics, or ocular inflammation in both eyes. Accordingly, we performed PPV on the right eye. During vitrectomy, we found a RAM on the optic disc with retinal hemorrhage on the nasal side. We carefully reviewed the preoperative color fundus photographs and noticed that RAM was not present on the optic disc at the time of his visit 4 months earlier. After surgery, his BCVA improved to 1.2, the color of the RAM on the optic disc changed to grayish yellow, and optical coherence tomography images showed a shrunken RAM. RAM on the optic disc could cause VH early after its onset.

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Vitreous Hemorrhage Caused by Ruptured Retinal Macroaneurysm

Cited by 5 publications

References 10 publications

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy

Multi‐layered haemorrhage secondary to retinal arterial macroaneurysm: A case report and review

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

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