Medical History
A 62-year-old female patient with vision loss in the left was examined in our clinic.
Diabetes mellitus (-)
Systemic hypertension (+)
Family history (-)
Smoking (-)
Trauma
Examination Findings
Best corrected visual acuity was 10/10 in the right eye and 1/10 in the left eye. Intraocular pressure was 12 mmHg in the right eye and 13 mmHg in the left eye. Anterior segment examination revealed nuclear sclerosis in both eyes. Fundus examination revealed arteriolar tortuosity in the right eye (Figure 1), lipid exudate at the fovea and lipid exudate with hemorrhage at the temporal quadrant and macroaneurysm in the left eye (Figure 2).
SD-OCT imaging shows subfoveal hyperreflectivity due to lipid exudate and sensory retinal detachment with intraretinal hyperreflectivity at the temporal side of the fovea (Figure 3).
The scan of superior temporal quadrant of SD-OCT imaging shows retinal artery macroaneurysm, sensory retinal detachment related to subretinal hemorrhage and intraretinal hyperreflectivity (Figure 4).
Fluorescein angiography (FA) examination shows hypofluorescence at the fovea and superior temporal quadrant and hyperfluorescent foci on the vessels (Figure 5) in the left eye.
Indocyanine green angiography (ICGA) examination shows hypofluorescence at the fovea and superior temporal quadrant and hyperfluorescent foci on the vessels (Figure 6) in the left eye.
Differential Diagnosis
Polypoidal choroidal vasculopathy (PCV)
Diagnosis
Ruptured retinal arter macroaneurysm
Retinal artery macroaneurysms are acquired focal dilations of retinal artery branches. They can be classified as hemorrhagic or exudative. Visual prognosis is good, but if macroaneurysm rupture develops, vision loss can be observed due to bleeding. Also, familial retinal artery macroaneurysm is a rare autosomal recessive disease, characterized by aneurysm formation along the main retinal arteries, bleeding and exudation. It was described by Dhinsa and Abboud in 2002, firstly. Supravalvular pulmonary stenosis may accompany familial retinal artery macroaneurysms. It is important to follow these patients with echocardiography.
Treatment
Small retinal artery macroaneurysms can be observed or focal laser photocoagulation therapy can be applied. In cases with bleeding, surgical treatment can be performed. In addition, intravitreal anti-VEGF injections can also be used for treatment.
References
- Lee EK, Woo SJ, Ahn J, Park KH. Morphologic characteristics of retinal arterial macroaneurysm and its regression pattern on spectral-domain optical coherence tomography. Retina 2011;31(10):2095-2101. https://pubmed.ncbi.nlm.nih.gov/21716167/
- Moorsavi RA, Fong KC, CHopdar A. Retinal artery macroaneurysms: clinical and fluorescein angiographic features in 34 patients. Eye (Lond) 2006;20(9):1011-1020. https://pubmed.ncbi.nlm.nih.gov/16138114/
