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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

Ahmet Ozkok, M.D.

University of Louisville

Department of Ophthalmology and Visual Sciences

1/23/14


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


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)





FA

00:15

00:21

00:24

D

00:29

00.52

05:21


FA

171 µ


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


  • RAM is a rareretinalvasculardisease

  • Commonlyassociatedwith HT

  • Can causedecreasedvision

    • Macularedema

    • Hemorrhage

  • FA or ICG is helpfulfordiagnosis

  • Complicationorientedtheraphy



  • 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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