Macroaneurysm Treatment & Management

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

Medical Care

Control hypertension and serum lipids.

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Surgical Care

  • Laser photocoagulation
    • The treatment of retinal macroaneurysms by direct laser photocoagulation is controversial.
    • The natural history of the disease suggests that many patients have significant visual recovery without treatment.
    • Treatment is generally recommended for persistent or progressive exudation in the macula.
    • Moderately heavy argon green or yellow dye laser is used with large spot size (500 µm) and long duration (0.5 s).
    • Direct treatment of the aneurysm is performed.
  • Laser hyaloidotomy
    • In the setting of dense subhyaloid hemorrhage, YAG laser hyaloidotomy has been performed to release the sequestered blood into the vitreous cavity.
    • Release of blood that is sequestered over the macula may reduce the risk of macular scarring and epiretinal fibrosis. This procedure is controversial because of the risk of macular injury and vitreous hemorrhage.
  • Surgical evacuation
    • In rare settings where vitreous hemorrhage is present and the etiology of bleeding is unclear, vitrectomy surgery may be indicated. Removal of dense subretinal hemorrhage is very controversial and has the potential of causing many serious complications.
    • The goal is to remove the extravasated blood and to assist in the diagnosis and possible treatment. Recently, pneumatic displacement of premacular hemorrhages using SF6 gas has also been reported.
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Consultations

Medical workup if not previously diagnosed with hypertension

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Diet

Per primary care provider

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Activity

Reducing the risk of the Valsalva maneuver in patients with active pulsatile retinal macroaneurysms may be beneficial. However, this has not been proven to reduce the incidence of hemorrhages in these patients.

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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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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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