Central serous chorioretinopathy in a patient with congenital retinal macrovessel

Congenital Retinal Macrovessel Without Any Ophthalmic Complications: A Case Report

Congenital retinal macrovessels (CRMs) are a rare entity. They are usually unilateral, abnormally large, and aberrant vessels. Although the majority of the patients are asymptomatic, CRMs may affect vision if they are associated with pigmentary changes at the macula, foveolar cysts, central serous retinopathy, macular hemorrhage, or if the macrovessel crosses the fovea. Here, we present the case of a young female who came for a routine ophthalmological evaluation. She was asymptomatic, and the macrovessel was an incidental finding. Visual acuity and slit lamp examination were normal, and dilated fundus evaluation was normal except for CRM in the right eye. Optical coherence tomography angiography imaging helped visualize the depth of the vessel and the analysis of the architecture of the foveal avascular zone.

Bilateral Congenital Retinal Macrovessel: A Case Report

Congenital retinal macrovessel (CRM) is a congenital anomaly where an aberrant vessel supplies both the macula on either side of the horizontal raphe. It is usually an incidental finding but may be associated with other retinal findings that may impact vision. We present an unusual case of bilateral congenital retinal macrovessel in a 40-year-old patient. The patient presented to the ophthalmology clinic for diabetic retinopathy screening and had no visual complaints. The patient underwent a complete ophthalmological examination including fundus imaging, fundus fluorescein angiography, and optical coherence tomography (OCT) imaging. Dilated fundus examination showed bilateral hypertensive retinopathy with optic disc collateral vessels and congenital retinal macrovessels. The multimodal imaging techniques that were used to confirm the finding indicated that the vessel is arterial.

Favourable outcome in retinal macrovessel-related choroidal neovascularization

Congenital retinal macrovessel (CRM) is an aberrant retinal blood vessel, which crosses the central macula and has tributaries extending on both sides of the horizontal raphe. It is a rare vascular condition, usually asymptomatic and incidentally discovered on routine fundus exam. This report describes a case of venous CRM associated with visual impairment secondary to choroidal nonvascular membrane (CNV). Treatment with intravitreal injection of aflibercept resulted in a favourable visual as well as anatomical outcome.

Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain

Importance

Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain.

Objective

To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations.

Design, Setting, and Participants

In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017.

Main Outcomes and Measures

Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available.

Results

Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%).

Conclusions and Relevance

Our study has identified an association between macrovessels in the retina and venous anomalies of the brain (24% compared with 0.2% to 6.0% in the normal population). Thus, we recommend new guidelines for the systemic workup of patients with CRM to include brain magnetic resonance imaging with contrast. These lesions may be more accurately referred to as retinal venous malformations, which may raise awareness regarding potential cerebral associations.

Congenital retinal macrovessel associated with vitreous hemorrhage

A "congenital retinal macrovessel" (CRM) is an aberrant retinal vessel (frequently a vein) that traverses the central macula and supplies or drains both above and below the horizontal raphe. It is an uncommon entity that is usually disclosed on routine examination and may rarely cause a compromised visual acuity. We describe the case of an adolescent girl who underwent vitrectomy for vitreous hemorrhage and was found to have a CRM with vascular abnormalities. To our knowledge, this is the first report of vitreous hemorrhage secondary to a CRM.

Intravitreal bevacizumab in congenital retinal macrovessel with retinal arteriolar macroaneurysm

Congenital retinal macrovessel (CRM) refers to an aberrant vessel, usually a vein, which traverses the macula and supplies both sides of the horizontal raphe. It is a rare condition, mostly asymptomatic and discovered on routine examination. We describe a case of both arterial and venous CRM with a macroaneurysm along the arterial CRM that presented with decreased vision due to prominent lipid exudation at the macula. Treatment with intravitreal bevacizumab resulted in a favourable anatomical as well as functional outcome. To the best of our knowledge, this is the first report of this unusual presentation of CRM, and its successful management with intravitreal bevacizumab.