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.