Retinal Imaging Conference
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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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Retinal imaging conference case presentation

Retinal Imaging Conference

Case Presentation

Ahmet Ozkok, M.D.

University of Louisville

Department of Ophthalmology and Visual Sciences

1/23/14


Retinal imaging conference case presentation

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


Retinal imaging conference case presentation

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)


Retinal imaging conference case presentation

Fundus


Retinal imaging conference case presentation

Autofluorescence


Retinal imaging conference case presentation

OCT


Retinal imaging conference case presentation

FA

00:15

00:21

00:24

D

00:29

00.52

05:21


Retinal imaging conference case presentation

FA

171 µ


Retinal imaging conference case presentation

Assessment

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


Differential diagnosis

Differential Diagnosis

  • Retinal arterial macroaneurysm

  • Branch retinal vein occlusion


Impression

Impression

  • CME associated with retinal arterial macroaneurysm


Course

Course

28th month 20/40


Retinal arterial macroaneurysm

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%)


Retinal arterial macroaneurysm1

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.


Retinal arterial macroaneurysm presentation

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


Retinal arterial macroaneurysm imaging

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


Retinal arterial macroaneurysm2

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


Retinal arterial macroaneurysm management

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


Retinal arterial macroaneurysm management1

Retinal Arterial MacroaneurysmManagement

  • Macular edema

    • Observe

    • Focal/grid laser

    • IVTA

    • Anti-VEGFs


Retinal arterial macroaneurysm management2

Retinal Arterial MacroaneurysmManagement

Am J Ophthalmol 2013;155:898–904


Retinal imaging conference case presentation

  • Conclusion

  • RAM is a rareretinalvasculardisease

  • Commonlyassociatedwith HT

  • Can causedecreasedvision

    • Macularedema

    • Hemorrhage

  • FA or ICG is helpfulfordiagnosis

  • Complicationorientedtheraphy


Retinal imaging conference case presentation

THANK YOU


Retinal imaging conference case presentation

  • 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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