Macroaneurysm Clinical Presentation

  • Author: Edward Chaum, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 26, 2012
 

History

  • Most patients present with sudden onset of painless vision loss in one eye.
  • If the central macula is spared, the patient may be asymptomatic.
  • Aneurysms that present without exudation or hemorrhage are asymptomatic.
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Physical

  • Aneurysmal dilation of the retinal arterioles occurs, usually at the site of vessel bifurcation or arteriovenous crossing in the major branch retinal arteries.
  • The right eye more commonly is affected.
  • The supertemporal artery most commonly is involved.
  • Macroaneurysms also have been reported in cilioretinal arteries and on the optic nerve head.
  • Occasionally, multiple aneurysms are present.
  • Pulsatile flow occasionally is observed but does not necessarily indicate a higher risk of hemorrhage.
  • Usually, leakage of protein-rich serum occurs, leading to circinate exudation and macular edema.
  • Serous retinal detachment can occur.
  • Bleeding is a common complication of aneurysm formation and can occur beneath the retina, the retinal pigment epithelium (RPE), the internal limiting membrane (ILM), or into the vitreous.
  • Clinical complications of retinal macroaneurysms include vitreous hemorrhage, retinal detachment, macular holes, and choroidal neovascular membrane formation.[6]
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Causes

  • The most commonly associated risk factor is hypertension.
  • Generalized arterial sclerosis is a common feature.
  • In some patients, serum lipid abnormalities have been reported.
  • In some patients, the Valsalva maneuver may be associated with an increased risk of hemorrhage.
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Contributor Information and Disclosures
Author

Edward Chaum, MD, PhD  Professor and Director, Vitreoretinal Service, Plough Foundation Professor of Retinal Diseases, Department of Ophthalmology, Professor of Pediatrics, Anatomy and Neurobiology, and Biomedical Engineering, University of Tennessee Health Science

Edward Chaum, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Retina Specialists, American Telemedicine Association, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell P Jayne, MD  Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  19. Tashimo A, Mitamura Y, Sekine N, Takeda M, Ohtsuka K. Rhegmatogenous retinal detachment after rupture of retinal arterial macroaneurysm. Am J Ophthalmol. Sep 2003;136(3):549-51. [Medline].

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Red-free photograph of left fundus of a 79-year-old woman presenting with decreased vision in left eye. This shows central macular exudation involving the fovea and intraretinal hemorrhages along the inferotemporal arcade. A whitish lesion is seen adjacent to the artery within the area of hemorrhage but is not well visualized. Visual acuity is 20/400.
Fluorescein angiogram during the venous phase demonstrating delayed filling of the retinal macroaneurysm with fluorescein dye. The aneurysm is obscured partially by the presence of hemorrhage, but filling by the dye enhances visualization.
Fluorescein angiogram during the late phase showing complete filling of the retinal macroaneurysm with fluorescein dye.
Fluorescein angiogram photograph taken 3 weeks after focal laser photocoagulation of the retinal macroaneurysm. Complete closure of the aneurysm is demonstrated. No embarrassment of arterial flow following treatment is present. The arterial lumen appears normal in the region of the aneurysm. Persistent macular edema is present.
 
 
 
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