Retinal macroaneurysm


Definition: Dilatation of vascular structure between 100-250 microns.

Site: Usually superotemporal at arteriovenous crossing or arteriolar bifurcation.

Demographics: Elderly female with hypertension.

Clinical features:

  1. Asymptomatic or sudden vision loss.
  2. Tri-layer bleed – subretinal, intraretinal or sub ILM bleed +/- retrohyaloid or VH.
  3. ERM after resolution.
  4. Macular hole formation following ruptured MA.

Investigations: FFA, ICG (pulsatile lesion), OCT, systemic evaluation (HTN and CVS).

Differential diagnosis: RVO ; angioma ; nAMD ; choroidal melanoma.

Management:

  1. Asymptomatic – observation
  2. Laser photocoagulation at macroaneurysm or perianeurysmal – macular oedema associated MA (take months to resolve) – risk of BRAO or CNV.
  3. YAG hyaloidotomy – sub-ILM or retrohyaloid bleed.
  4. Pneumatic displacement – small subfoveal bleed
  5. PPV – dense VH
  6. Anti-VEGF – early promising results for MA associated macular oedema.

BRAO: Branch retinal artery occlusion; CNV: choroidal neovascularisation; CVS: cardiovascular; ERM: epiretinal membrane; FFA: fundus fluorescein angiogram; ICG: indocyanine green angiography; ILM: internal limiting membrane ; MA: macroaneurysm; nAMD: neovascular age-related macular degeneration; OCT: Optical Coherence Tomography; PPV: pars plana vitrectomy; RVO: retinal vein occlusion; VH: vitreous haemorrhage


Reference:


Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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