Retinal Arterial Macroaneurysm
Retinal Arterial Macroaneurysm (RAM) is a dilation of retinal arterioles that occur within the first three orders of arteriolar bifurcation. Macroaneurysms range from 100 to 250μm in diameter. Associated findings include capillary telangiectasias, vascular remodeling, and retinal edema. The supratemporal artery is the most common site of involvement because patients are more likely to have visual impairment when presenting in these quadrants.
EPIDEMIOLOGY
Women make up the majority of reported cases. Most common age group is 60 – 70 years. Most cases are unilateral, while 10% may be bilateral. In the Beijing Eye Study, Retinal macroaneurysm was estimated to occur in 1 in 9000.1
RISK FACTORS
Associated risk
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Dense hemorrhage in the retina can cause marked hypofluorescence. In such cases of dense hemorrhage, indocyanine green angiography may be useful because its absorption and emission peak in the near-infrared range allow the light to penetrate the hemorrhage to a greater extent than fluorescein angiography.9 A small case series using indocyanine green angiography has demonstrated these lesions to be pulsatile and contiguous with the arterial wall, pathognomonic of an isolated retinal artery macroaneurysm.10 The macroaneurysm typically fills in the early arterial phase of the angiogram. The appearance of the late phase of the fluorescein angiogram varies, ranging from little staining of the vessel wall to marked leakage. Leakage of surrounding dilated capillaries also may be seen. The lipid often present in the macular area fails to block fluorescein unless the amount of lipid is …show more content…
Some authors have reported a good visual outcome simply with observation. Even though there is no consensus about the management of retinal arterial macroaneurysm, treatment is advised in cases of exudative manifestations involving the fovea with visual acuity deterioration.12,13,14
Therapeutic interventions for eyes with retinal arterial macroaneurysm include direct photocoagulation to the aneurysm itself,15 pneumatic displacement with tissue plasminogen activator for submacular hemorrhage secondary to retinal arterial macroaneurysm,16,17 surgical removal of associated hemorrhage with pars plana vitrectomy,18,19 and photodisruption of the internal limiting membrane (ILM) or the posterior hyaloid using neodymium:yttrium-aluminum-garnet (Nd:YAG) or argon laser to release the