Macroaneurysm Workup

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

Laboratory Studies

  • Blood pressure is likely to be elevated.
  • Serum lipids may be elevated.
  • Blood glucose is likely in the reference range. This test may be indicated to exclude undiagnosed diabetes in patients with exudative retinopathy in which the etiology is unclear.
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Imaging Studies

  • Fluorescein angiography is the most helpful imaging study for the diagnosis.
    • Saccular dilation of the arteriolar wall is diagnostic of the disease.
    • The angiogram is particularly important in making the diagnosis when hemorrhaging (which obscures the vasculature) occurs.
    • Late fluorescein leakage from within the areas of hemorrhage is characteristic of the aneurysms and may assist in the diagnosis when the vasculature is not visible on direct examination. Fluorescein angiogram during the venous phase demoFluorescein 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 showinFluorescein angiogram during the late phase showing complete filling of the retinal macroaneurysm with fluorescein dye. Fluorescein angiogram photograph taken 3 weeks aftFluorescein 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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Other Tests

  • B-scan (and possibly A-scan) ultrasound may be indicated to rule out a choroidal mass or hemorrhagic retinal detachment in cases of hemorrhagic RPE detachment that may simulate a choroidal melanoma or a dense vitreous hemorrhage (which obscures visualization of the posterior pole).
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Histologic Findings

Microvascular abnormalities (eg, widening of the periarterial capillary free zone, capillary dilation, nonperfusion, intra-arterial collaterals) have been identified. Histologic studies of the macroaneurysm show a break in the arterial wall, surrounded by a laminated layer of fibrin-platelet clot and blood. Lipid-laden macrophages, hemosiderin, and fibroglial reaction are also observed.

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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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