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Retinal Imaging Conference Case Presentation

Retinal Imaging Conference Case Presentation. Ahmet Ozkok , M.D. University of Louisville Department of Ophthalmology and Visual Sciences 1/23/1 4. History. CC : ‘blurred vision in the left eye for 2 weeks ’

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Retinal Imaging Conference Case Presentation

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  1. Retinal Imaging Conference Case Presentation Ahmet Ozkok, M.D. University of Louisville Department of Ophthalmology and Visual Sciences 1/23/14

  2. History • CC: ‘blurred vision inthe left eyefor 2 weeks’ • HPI: 83 y/o C F;Blurred visionand trouble focusing noticed 2 weeks ago, gradually increasing. • PMHx: Hyperlipidemia, Arrhythmia, HT • Meds: ASA, Simvastatin, lisinopril • Allergies: NKDA • Family Hx: Heart disease

  3. 4→2 20/20 (pl) 4→2 • 20/50 (+0.25, +0.25×015) Ocular Examination VAcc P No RAPD OU EOM: full OU CVF: full OU IOP: 17 / 13 mmHg Anterior Segment : WNL OU except for PCIOL (OU)

  4. Fundus

  5. Autofluorescence

  6. OCT

  7. FA 00:15 00:21 00:24 D 00:29 00.52 05:21

  8. FA 171 µ

  9. Assessment • Assessment: 83 y/o female with decreased vision, localized intraretinalhemorrhage in the macula, CME, and aneurysm in the left eye.

  10. Differential Diagnosis • Retinal arterial macroaneurysm • Branch retinal vein occlusion

  11. Impression • CME associated with retinal arterial macroaneurysm

  12. Course 28th month 20/40

  13. Retinal Arterial Macroaneurysm • 1/9000 in Beijing eye study • 90% unilateral • Most commonly develop in women (70%/30%) aged between 50-80 • Often associated with HT (65%)

  14. Retinal Arterial Macroaneurysm • Saccular or fusiform dilations of the retinal arterioles within the first three orders of arteriolar bifurcation • They are usually located at the side of an arteriolar bifurcation or AV crossing • ST artery is the most commonly reported site.

  15. Retinal Arterial MacroaneurysmPresentation • Presents with decline in visual acuity due to retinal edema, exudation or hemorrhage • Hemorrhagic RAM • Vitreous, sub-ILM, intraretinal, subretinal, sub-RPE • Exudative RAM • Quiescent RAM

  16. Retinal Arterial MacroaneurysmImaging • FA for demonstration of RAM • ICG may be helpful in cases with dense hemorrhage • Anatomical nature of aneurysm • Saccular • Fusiform Eye (2006) 20, 1011–1020

  17. Retinal Arterial Macroaneurysm • Fibrotic changes in the media of arterial wall • Traction on the adventitia of that segment both by medial layer and ILM • Z-Shaped kink sign

  18. Retinal Arterial MacroaneurysmManagement • Spontaneous obliteration of aneurysm with functional recovery is possible • Aneurysm • Direct photocoagulation to the aneurysm itself • Hemorrhage • Pneumatic displacement w/wotPA • Yag laser for premacular hemorrhage (Photodistruption of ILM) • Vitrectomy

  19. Retinal Arterial MacroaneurysmManagement • Macular edema • Observe • Focal/grid laser • IVTA • Anti-VEGFs

  20. Retinal Arterial MacroaneurysmManagement Am J Ophthalmol 2013;155:898–904

  21. Conclusion • RAM is a rareretinalvasculardisease • Commonlyassociatedwith HT • Can causedecreasedvision • Macularedema • Hemorrhage • FA or ICG is helpfulfordiagnosis • Complicationorientedtheraphy

  22. THANK YOU

  23. Ryan, Stephen J.; Schachat, Andrew P.; Wilkinson, Charles P.; Hinton, David R.; Sadda, SriniVas R.; Wiedemann, Peter (2012-11-01). Retina (Ryan, Retina) (Kindle Location 60653). Elsevier Health Sciences. Kindle Edition. • Cho HJ, Rhee TK, Kim HS, et al. Intravitrealbevacizumabforsymptomaticretinalarterymacroaneurysm. Am J Ophthalmol 2013;155:898-904 • Moosavi RA, Fong KC, Chopdar A. Retinalarterymacroaneurysms: clinicalandfluoresceinangiographicfeatures in 34patients.Eye (Lond). 2006 Sep;20(9):1011-20. Epub 2005 Sep 2. • .

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