Vitreous and Retina

Retinal Artery Macroaneurysm

Retinal arterial macroaneurysm in the left supratemporal artery demonstrating typical circinate configuration of hard exudates and lipoprotein exudation involving the foveal avascular zone. Note the focal fusiform hyperfluorescence of the macroaneurysm.
  • Aquired retinal vascular abnormalities.
  • Mostly affects women.
  • Most commonly involves supratemporal artery.
  • Associated with systemic arterial hypertension in about 60% of cases.

Clinical Features

  • Symptoms:
    • Maybe asymptomatic
    • Decreased visual acuity if retinal edema, exudation and hourglass hemorrhages involving the macular area
  • Signs:
    • Round or fusiform dilations of retinal arteries within the first three orders of arteriolar bifurcation
    • Usually unilateral
    • Occasionally multiple
    • Retinal edema
    • Circinate configuration of lipoprotein exudation in the nerve fiber layer
    • May present with hemorrhages into the retinal, subretinal space or vitreous cavity (hourglass hemorrhages)
  • Fluorescence angiography typically demonstrates:
    • Early hyperfluorescence
    • Staining of the vessel wall or various degree of dye leakage in the late phase
    • The aneurysm may not be visible due to the blockage of associated hemorrhage and/or hard exudate
  • Management with laser photocoagulation in selected cases.