Optometry Continuing Education

Review of Retinal Artery Macroaneurysm

    • CE credits 2 hours
    • COPE code 55503-PS / 114504
    • Available until Oct 20, 2020
    • $29

Introduction

Objectives

  • To review the pathophysiology and etiology of retinal arterial macroaneurysms
  • To review the management of retinal arterial macroaneurysms

Case

A 73-year-old female presents with a history of waking with visual blurring in the left eye three days earlier. She has also noted new floaters since then. Although it has improved mildly since then, she still complains of seeing poorly from the eye. There is no history of eye pain or flashes, and she reports no problems with the right eye. Her past medical history is significant for hypertension, hypothyroidism, and osteoporosis while her past ocular history is unremarkable.

On examination, best-corrected visual acuity is 20/20 and 20/80 in the right and left eyes, respectively. Anterior segment exam is normal. Posterior segment exam of the left eye is shown below:

Quick Question

What is the most likely diagnosis?

  • Diabetic retinopathy

    Although proliferative diabetic retinopathy is a common source of vitreous hemorrhage, there is no known history of diabetes in the patient, and nor is there signs of diabetic retinopathy present in either eye.

  • Age-related macular degeneration

    Neovascular age-related macular degeneration (AMD) can occasionally cause a vitreous hemorrhage. While there is fibrosis in this patient (white area near superior temporal artery), it is more superficial as compared to the deep fibrosis seen with AMD. The determination of the depth of fibrosis is made on stereoscopic examination and most often cannot be ascertained on a colour photo.

  • Posterior vitreous detachment

    Posterior vitreous detachment is an age-related shrinkage of the vitreous humour that can often cause vitreous hemorrhage when associated with a retinal tear or avulsion of a small papillary vessel. It is not associated with the fibrosis seen in this image.

  • Retinal arterial macroaneurysm
    CORRECT

Introduction

Retinal arterial macroaneurysms (RAMs) are acquired dilatations of the retinal vasculature that are often associated with longstanding hypertension. They are usually asymptomatic unless they either rupture causing hemorrhage, or become very permeable causing retinal edema. At times the rupture of the aneurysm is forceful enough to breakthrough into the vitreous. In this case, the patient may present with a new onset of floaters and a sudden, severe reduction in vision. RAM is most commonly seen in the elderly (6th-8th decade) and have a slight female preponderance.1 The average age of onset 66.1-73.7.2,3

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