Macroaneurysm

Author: Edward Chaum, MD, PhD; Chief Editor: Hampton Roy Sr, MD more...

Updated: Feb 23, 2010

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Background
Pathophysiology
Epidemiology
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Background

Retinal macroaneurysms are acquired, usually round, dilations of the large arterioles of the retina. Macroaneurysms are associated with systemic hypertension in approximately 75% of patients. They commonly are associated with macular exudation and hemorrhage, which may result in decreased visual acuity. A 10% incidence of bilateral disease exists, and multiple aneurysms in the same eye occasionally are seen.^{[1, 2, 3]}

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.

Pathophysiology

Formation of retinal macroaneurysms is associated with systemic hypertension and atherosclerotic disease, but serum lipid abnormalities also have been reported. About 10% of patients have focal arterial wall atheroma occurring at defects in the wall, which may be sites at risk of aneurysm formation. The aneurysms are sites of leakage of exudates and hemorrhage in the macula. Over time or after acute hemorrhage, spontaneous thrombosis and closure of the aneurysm may occur; in some cases, the artery may return to normal.^{[4, 5]}

Frequency

United States

Not reported

International

Not reported

Mortality/Morbidity

The visual prognosis in many patients is excellent, but vision loss that results from retinal macroaneurysm formation usually results from scarring in the macula due to either chronic edema or hemorrhage.

Race

No racial predilection exists.

Sex

The female-to-male ratio is 3:1.

Age

This condition occurs most commonly in the sixth to seventh decade. This condition is rare before age 60 years.

Proceed to Clinical Presentation

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, Association for Research in Vision and Ophthalmology, and Juvenile Diabetes Foundation International

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 Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

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 & 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 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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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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