Isolated retinal arterial aneurysms

Retinal arterial macroaneurysms

Retinal arterial macroaneurysms represent a distinct clinical entity. Macroaneurysms are seen in the elderly with a marked female predominance and a strong association with hypertension and arteriosclerotic vascular changes. The classic appearance provides an easy diagnosis; however, variable presentations, such as subretinal hemorrhage, macular exudate, and epiretinal membranes can make the diagnosis difficult. The differential diagnosis of retinal arterial macroaneurysms include retinal telangiectasia, angiomatosis retinae, venous macroaneurysms, background diabetic retinopathy, and cavernous hemangioma. The clinical characteristics of the reported cases are summarized, and our series of 60 patients is presented. The natural history of most macroaneurysms is spontaneous involution without loss of vision. However, visual loss may occur secondary to macular edema, exudate, hemorrhage and neurosensory retinal detachment, and photocoagulation may expedite visual recovery. Photocoagulation treatment may be applied directly to the macroaneurysm, indirectly by surrounding the macroaneurysm, or as a combination of these two methods.

Retinal arterial macroaneurysms: a retrospective study of 40 patients

We studied 40 patients with a total of 44 retinal arterial macroaneurysms. All patients were followed up for at least six months. Macroaneurysms (MAs) have variable clinical presentations and are still frequently misdiagnosed before fluorescein angiography. Haemorrhagic MAs were most frequently misdiagnosed (75%), and had a sudden onset with a relatively poor visual outcome. Patients with these MAs had higher systolic blood pressures and significantly fewer associated retinal vein occlusions (p less than 0.05) than other types of MA. Exudative MAs caused a gradual onset of symptoms, were frequently associated with retinal vein occlusions, and were the most frequent indication for laser treatment. Only one of 10 quiescent MAs subsequently developed significant exudation or haemorrhage. We confirm the association of MAs with retinal and systemic vascular disease. In addition we found that MA patients had a significantly higher blood packed cell volume (haematocrit) than controls (p less than 0.05). Laser treatment significantly shortened the duration of MA patency (p = 0.006).

A histopathologic study of retinal arterial aneurysms

An isolated retinal arterial aneurysm was found postmortem in the eye of a 75-year-old hypertensive woman, and multiple aneurysms were in the enucleated eye of a 68-year-old hypertensive man with neovascular glaucoma. The aneurysmal sites showed thickening of the vessel walls with hyaline, fibrin, and foamy macrophages. Fresh or organized thrombus partially filled the aneurysmal lumina. Trypsin digestion preparations in Case 2 showed a progressive severity of aneurysmal changes from the simplest "cuff" type to the hemorrhagic "b;pwout" aneurysms with a linear split in the vessel wall. Atheroma was present in the larger arterial branches and fat was in most of the aneurysmal walls. These findings suggested that damage to the arterial wall by cholesterol or other emboli, or by occlusive disease, may predispose especially hypertensive patients to arterial aneurysm formation.