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Retinal Arterial Macroaneurysm: Case Presentation and Clinical Management Insights

This case presentation discusses an 83-year-old female patient experiencing blurred vision in her left eye for two weeks, accompanied by decreased visual acuity and localized intraretinal hemorrhage. A comprehensive ocular examination revealed findings consistent with cystoid macular edema (CME) and a retinal arterial macroaneurysm. The presentation reviews the potential complications, including hemorrhage and edema, and outlines management options ranging from observation to laser treatments and intravitreal injections. This highlights the importance of proper diagnostic imaging and tailored therapeutic strategies in retinal vascular diseases.

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Retinal Arterial Macroaneurysm: Case Presentation and Clinical Management Insights

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Presentation Transcript

  1. Retinal Imaging Conference Case Presentation Ahmet Ozkok, M.D. University of Louisville Department of Ophthalmology and Visual Sciences 1/23/14

  2. History • CC: ‘blurred vision inthe left eyefor 2 weeks’ • HPI: 83 y/o C F;Blurred visionand trouble focusing noticed 2 weeks ago, gradually increasing. • PMHx: Hyperlipidemia, Arrhythmia, HT • Meds: ASA, Simvastatin, lisinopril • Allergies: NKDA • Family Hx: Heart disease

  3. 4→2 20/20 (pl) 4→2 • 20/50 (+0.25, +0.25×015) Ocular Examination VAcc P No RAPD OU EOM: full OU CVF: full OU IOP: 17 / 13 mmHg Anterior Segment : WNL OU except for PCIOL (OU)

  4. Fundus

  5. Autofluorescence

  6. OCT

  7. FA 00:15 00:21 00:24 D 00:29 00.52 05:21

  8. FA 171 µ

  9. Assessment • Assessment: 83 y/o female with decreased vision, localized intraretinalhemorrhage in the macula, CME, and aneurysm in the left eye.

  10. Differential Diagnosis • Retinal arterial macroaneurysm • Branch retinal vein occlusion

  11. Impression • CME associated with retinal arterial macroaneurysm

  12. Course 28th month 20/40

  13. Retinal Arterial Macroaneurysm • 1/9000 in Beijing eye study • 90% unilateral • Most commonly develop in women (70%/30%) aged between 50-80 • Often associated with HT (65%)

  14. Retinal Arterial Macroaneurysm • Saccular or fusiform dilations of the retinal arterioles within the first three orders of arteriolar bifurcation • They are usually located at the side of an arteriolar bifurcation or AV crossing • ST artery is the most commonly reported site.

  15. Retinal Arterial MacroaneurysmPresentation • Presents with decline in visual acuity due to retinal edema, exudation or hemorrhage • Hemorrhagic RAM • Vitreous, sub-ILM, intraretinal, subretinal, sub-RPE • Exudative RAM • Quiescent RAM

  16. Retinal Arterial MacroaneurysmImaging • FA for demonstration of RAM • ICG may be helpful in cases with dense hemorrhage • Anatomical nature of aneurysm • Saccular • Fusiform Eye (2006) 20, 1011–1020

  17. Retinal Arterial Macroaneurysm • Fibrotic changes in the media of arterial wall • Traction on the adventitia of that segment both by medial layer and ILM • Z-Shaped kink sign

  18. Retinal Arterial MacroaneurysmManagement • Spontaneous obliteration of aneurysm with functional recovery is possible • Aneurysm • Direct photocoagulation to the aneurysm itself • Hemorrhage • Pneumatic displacement w/wotPA • Yag laser for premacular hemorrhage (Photodistruption of ILM) • Vitrectomy

  19. Retinal Arterial MacroaneurysmManagement • Macular edema • Observe • Focal/grid laser • IVTA • Anti-VEGFs

  20. Retinal Arterial MacroaneurysmManagement Am J Ophthalmol 2013;155:898–904

  21. Conclusion • RAM is a rareretinalvasculardisease • Commonlyassociatedwith HT • Can causedecreasedvision • Macularedema • Hemorrhage • FA or ICG is helpfulfordiagnosis • Complicationorientedtheraphy

  22. THANK YOU

  23. Ryan, Stephen J.; Schachat, Andrew P.; Wilkinson, Charles P.; Hinton, David R.; Sadda, SriniVas R.; Wiedemann, Peter (2012-11-01). Retina (Ryan, Retina) (Kindle Location 60653). Elsevier Health Sciences. Kindle Edition. • Cho HJ, Rhee TK, Kim HS, et al. Intravitrealbevacizumabforsymptomaticretinalarterymacroaneurysm. Am J Ophthalmol 2013;155:898-904 • Moosavi RA, Fong KC, Chopdar A. Retinalarterymacroaneurysms: clinicalandfluoresceinangiographicfeatures in 34patients.Eye (Lond). 2006 Sep;20(9):1011-20. Epub 2005 Sep 2. • .

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