Retinal arterial macroaneurysm

Retinal arterial macroaneurysms (RAM) are acquired, localized, vascular dilations that occur at arteriovenous crossings or within the first three orders of retinal arterial bifurcation. They are most frequently seen unilaterally in hypertensive, elderly females over the age of sixty. The majority of patients are asymptomatic; however, acute vision loss can occur and is most commonly associated with retinal hemorrhaging or exudation. Submacular hemorrhages have the poorest visual prognosis because of permanent damage to the retinal pigment epithelium and photoreceptors. Other complications of RAMs include retinal edema, serous macular detachment, epiretinal membranes, macular hole, choroidal neovascularization, and retinal vein occlusions. Intravenous fluorescein angiography (IVFA) and indocyanine green angiography (ICGA) can aid in the diagnosis. Treatments include argon laser photocoagulation, laser photodisruption, vitrectomy, tissue plasminogen activator, and surgical excision. An atypical case of multiple RAMs with surrounding intraretinal hemorrhages will be discussed.