A 75-year-old female patient presented with a complaint of progressively worsening vision loss in her left eye. The patient had no systemic disease other than hypertension. The BCVAs were 8/10 in the right eye and 4/10 in the left eye with normal intraocular pressures. In the anterior segment examination, no pathology other than nuclear sclerosis was observed.
While the fundus examination of the right eye was normal; in the left eye a vascular dilatation area at the distal of the second branch of the inferior temporal retinal artery, macular lipid deposition in a circinate pattern in the area extending from the vascular dilatation area to the fovea and macular edema were observed.
Fundus fluorescein angiography showed uniform filling up and fusiform dilation of the vascular lesion.
Optical coherence tomography scans revealed oval hyperreflective lesion in the inner retinal layers in additon to serous macular detachment and intraretinal fluid with hyperreflective intraretinal exudate.
In light of these imaging finding, the diagnosis was retinal arterial macroaneurysm; which was treated with moderate-intensity laser photocoagulation with two to three rows of large-spot-size (200-500μm) immediately adjacent to the macroaneurysm. Two-months after laser photocoagulation, fundus examination showed that exudations decreased and the aneurysm scarred, fundus fluorescein angiography showed that the hypofluorescence of aneurysm with no leakage and optical coherence tomograpy exhibited the disappearance of intraretinal fluid and serous macular detachment.
Retinal arterial macroaneurysm (RAM) is an acquired aneurysmal dilation of the retinal arteriole wall that most commonly arises within the first three orders of arterial bifurcation. The most important risk factors associated with RAM are chronic systemic hypertension (75% of patients), atherosclerotic disease, and serum lipid abnormalities. Although RAMs are often asymptomatic, patients with RAM can present with central vision loss due to exudation, edema, or hemorrhage in the macula secondary to RAM.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
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