Secondary macroaneurysm due to aberrant retinal macrovessel

Author: Margarida Baptista (Portugal)

Co-authors: Mariana Portela, Pedro Arede, Fernanda Vaz, Maria Picoto

Purpose

Retinal arterial macroaneurysms are pathological round or fusiform dilations of retinal arterial branches. Although frequently related to chronic hypertension and lipid abnormalities, their exact pathogenesis remains undetermined. Retinal macrovessels consist of dilated vessels with end branches extending beyond the horizontal raphe. Arteriovenous transition of these abnormal vessels usually occurs via the capillary plexus, thus contributing to local blood flow turbulence and retinal vessel frailty. The aim of this report is to describe a clinical case where these entities overlap and their respective management, highlighting the importance of an appropriate follow-up.

Setting/Venue

Egas Moniz Hospital, Western Lisbon Hospital Center. Lisbon, Portugal.

Methods

A 54-year-old woman presented in the Ophthalmology Emergency Department complaining of floaters and photopsia in the left eye (LE). Ophthalmologic examination disclosed a LE best corrected visual acuity (BCVA) of 5/10, with unremarkable anterior segment observation. LE dilated fundus examination revealed an arteriolar dilation close to an aberrant retinal macrovessel, temporal to the macula and with surrounding exudates. The retinal macrovessel originated in the optic disk and coursed through the fovea and the horizontal raphe. The right eye had a BCVA of 10/10 and presented no abnormalities. Past ophthalmological history included LE pars plana vitrectomy 1 year before, due to a pre-macular haemorrhage secondary to Valsalva retinopathy. No vascular lesions suggestive of macroaneurysm were observed then. Remaining medical history reported smoking habits and previously treated breast neoplasm, with the absence of systemic hypertension and dyslipidaemia.

Results

Pursuit of macular involvement required further characterization. Optical Coherence Tomography (OCT) demonstrated a round cavity with a hyperreflective wall in the inner retinal layers suggestive of a macroaneurysm, with associated lipid deposits and intraretinal fluid. Central Foveal Thickness (CFT) was 395 µm. OCT-Angiography presented retinal blood flow abnormalities and no signs of choroidal neovascularization. The patient was proposed for LASER treatment of the macroaneurysm to prevent further macular edema. Focal argon LASER photocoagulation was performed in two sessions using a direct LASER technique, to accomplish macroaneurysm sclerosis. 2 months follow-up OCT scans showed a CFT of 307 µm, vessel closure and subsequent resolution of macular edema. Last BCVA was 7/10.

Conlusions

Retinal arterial macroaneurysms have an overall benign prognosis, however symptomatic and active lesions such as macular edema and exudates dictate treatment. LASER treatment choice remains controversial. This clinical case reported how retinal vascular abnormalities can severely affect visual function and may elucidate other pathological mechanisms for the development of vessel damage. Furthermore, it is important to emphasize the need to have a case-to-case follow-up plan to ensure early detection of complications associated with aberrant vessels and prompt LASER treatment.

Financial Disclosure

no financial relations

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