Answer to clinical quiz

Diagnosis: Retinal macroaneurysm [Figure 1] and [Figure 2]

Management: Laser photocoagulation [Figure 3]

Patients with retinal macroaneurysms are typically females in the 50-80 age range. Over 50% of patients have concurrent systemic arterial hypertension. These patients also have an increased incidence of cardiovascular disease. Ophthalmoscopy reveals an isolated dilatation of a major arterial branch, which is unilateral in 90% of cases but may be multifocal. Most often, by the time the patient presents, the aneurysm has leaked significantly with circinate exudation, macular edema, and extensive intra-retina and/or subretinal hemorrhage. With fluorescein angiography, the aneurysm hyperfluoresces early in the angiogram with a characteristic balloon appearance. Frequently, the patient is asymptomatic. However, if the macula is involved, the patient will present with reduced acuity and field. Spontaneous sclerosis and occlusion typically occurs with macroaneurysms, particularly after hemorrhaging. Asymptomatic non-leaking macroaneurysms may be monitored at four- to six-month intervals. If leakage takes the form of exudation and/or hemorrhage and threatens the macula, or if there is persistent macular edema, photocoagulation is indicated.