This patient had a retinal artery macroaneurysm presenting as a fibrotic mass along the superotemporal arcade with associated intraretinal and subretinal hemorrhaging and macular edema. The OCT of the right eye revealed drusen and a neurosensory detachment with reflective material that likely represents red blood cells. The OCT of the left eye showed drusen. With a significant loss of vision, anti-VEGF treatment with a sample of Eylea was recommended, to which she agreed. When seen 5 weeks later, the OCT revealed that the macular edema had nearly resolved. Clinically, the hemorrhaging was reduced and the vision had improved to 20/100-1.
Retinal artery macroaneurysm is a bulging of the arterial wall due to focal weakness of the blood vessel wall. It is associated with hypertension. Patients can loss vision from preretinal, intraretinal, or subretinal hemorrhage; or from macular edema. The typical clinical course involves fibrosis of the macroaneurysm and resolution of the hemorrhage and edema, but the bleeding and/or swelling can damage photoreceptors. Given evidence that anti-VEGF treatment might expedite resolution of the edema (1,2), a sample of Eylea was given to our patient, which appeared to improve the clinical course.
1. Sweifel, SA, Tönz MS, Pfenniger L, Becker M, Michels S. Intravitreal anti-VEGF therapy for retinal macroaneurysm. Klin Monbl Augenkeilka 2013;230:392-5.
2. Cahuzac A, Scemama C, Mauget-Faÿsse M, Sahel J-A, Wolf B. Retinal arterial macroaneurysms: clinical, angiographic, and tomographic description and therapeutic management of a series of 14 cases. Eur J Ophthalmol 2016;26:36-43.