SIGNS AND SYMPTOMS
Ophthalmoscopy reveals an isolated dilatation of a major arterial (or, rarely, venous) branch, which is unilateral in 90 percent of cases but may be multifocal. Most often, by the time the patient presents, the aneurysm has leaked significantly with exudate and extensive intra-retina and/or subretinal hemorrhage. Occasionally, you may note spontaneous pulsation of the aneurysm.
When there is extensive hemorrhage, you may have difficulty assessing retinal macroaneurysm as the cause; neovascularization is often misdiagnosed as the cause. If the focal dilatation is not apparent on ophthalmoscopy, use fluorescein angiography. With fluorescein angiography, the aneurysm hyperfluoresces early in the angiogram with a characteristic balloon appearance with later-phase leakage.
Frequently, the patient is asymptomatic. However, if the macula is
involved, the patient will present with reduced acuity and field. In these cases,
permanent vision reduction is possible.
However, if hemorrhage threatens or involves the macula, or if there is
persistent macular edema, photocoagulation is indicated. In these cases, moderately
intense photocoagulation should be applied directly to the macroaneurysm so as not to
produce complete occlusion of the involved artery. Venous macroaneurysms should be treated
in the same manner. Also, if you observe a non-hemorrhagic macroaneurysm spontaneously
pulsate, then direct photocoagulation should be used since rupture is likely.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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