Macroaneurysms of the retinal arteries

Macroaneurysms of the retinal arteries are represented by local expansion of the retinal arterioles, most often of the 1st, 2nd and 3rd order. Elderly women with arterial hypertension are most predisposed to them; in 90% of cases the process is unilateral.

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Symptoms of retinal artery macroaneurysm

Manifestations of retinal artery macroaneurysm may be reduced to one of the following:

• Incidental discovery of asymptomatic disorders
• Latent decrease in central visual acuity caused by macular edema and the formation of hard exudate.
• Sudden loss of vision with vitreous hemorrhage is rare.

Fundus of the eye

• Saccular or spindle-shaped dilations of arterioles most often appear in the area of bifurcations or arteriovenous crossings along the temporal vascular arcades. Aneurysms can enlarge, exceeding the diameter of the artery several times.
• Associated retinal hemorrhage is observed in 50% of cases.
• Multiple microaneurysms can be observed along the course of the same or different arterioles.

Foveal angiography depends on the nature of the disorders and associated hemorrhages. Homogeneous filling of macroaneurysms with late exudation is typical. Incomplete filling is due to partial or complete thrombotic obliteration of the vessel lumen.

Course of retinal artery macroaneurysm

• Spontaneous involution followed by thrombosis and fibrosis is observed most often. This is preceded by the development of oozing or hemorrhage.
• The rupture with hemorrhage may be subretinal, intraretinal, preretinal or vitreous. In such cases, the underlying changes may not be detected during examination.
• Chronic retinal edema with accumulation of hard exudate around the fovea is common and can cause persistent loss of central vision.

Differential diagnosis of retinal artery macroaneurysm

Hard exudates of the posterior segment

• Non-proliferative diabetic retinopathy.
• Exudative form of age-related macular degeneration.
• Long-standing occlusion of the branch of the central retinal vein.
• Retinal telangiectasias.
• Small hemangiomas of retinal capillaries.
• Radiation retinopathy.

Deep retinal or subretinal hemorrhages of the posterior segment

• Choroidal neovascularization.
• Valsalva retinopathy.
• Idiopathic polypoid choroidal vasculopathy.
• Blunt trauma to the eye.
• Choroidal melanoma.

Terson syndrome with subarachnoid hemorrhage.

Treatment of retinal artery macroaneurysm

1. Observation for early spontaneous involution is indicated in the presence of good visual acuity without macular changes, as well as in the presence of minor retinal hemorrhages in the absence of significant edema or exudation.
2. Argon laser coagulation is used in cases of edema or deposits of hard exudate with the risk of involving the fovea, especially if deterioration of vision is detected. Coagulates are applied to focal changes and/or to the surrounding area. Resorption of edema and hard exudate occurs within several months.
3. YAG laser hyaloidotomy may be indicated for extensive, non-resolving preretinal hemorrhages covering the macula to cause dispersion of blood into the vitreous cavity where absorption occurs more rapidly.