Macroaneurysm
 

There is a localized dilatation of the retinal artery (there may be multiple aneurysms) with surrounding  area of hard exuedate (which may be retinal and/or subretinal). There may be associated  retinal/subretinal/preretinal/vitreous haemorrhages. The appearance is that of a macroaneurysm. Look for: exudate in the macula artery occlusion or embolus distal to the site of macroaneurysm hypertensive changes of the retinal vessels

Questions:

1. Where is the most common location for macroaneurysm?

Answer
It is usually seen in the temporal arcade within the first three orders of the retinal artery.

2. What conditions are associated with  macroaneurysm?

Answer
It is associated with systemic hypertension and arteriosclerosis.

3. How does macroaneurysm normally present?

Answer
The condition may be asymptomatic if the aneurysm is situated outside the macula and does not bleed or leak. In such cases it may be an incidental finding on routine eye examination.
In symptomatic cases, the patients usually present with either a sudden onset visual disturbance or a slowly progressive visual loss. Sudden visual loss is usually caused by haemorrhage into the vitreous/retinal/subretinal spaces. Progressive visual loss results from slow leakage of the exudate into the macula.

4. How would you manage a macroaneurysm?

Answer
If the condition is asymptomatic, observation is all that is needed. The aneurysm may close spontaneously.
If the aneurysm is symptomatic such as causing haemorrhage or leakage into the macula. Laser photocoagulation targeted at or around the lesion may close the aneurysm. The laser should be applied lightly as there is risk of haemorrhage and arterial occlusion following laser treatment.

Return to the main page