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.

 
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