Retinal macroaneurysms are an acquired vascular anomaly primarily associated with advancing age and hypertension. Although a rare pathology, it is not uncommon for a patient with a macroaneurysm to present to the primary care optometrist. Macroaneurysms have various presentations and they constitute one of the few clinical entities that can produce preretinal, intraretinal, subretinal or vitreal haemorrhage or any combination thereof. A review of the pathophysiology, differential diagnosis and newest treatments will be provided.A 68-year-old Caucasian male patient with a history of a previously treated retinal macroaneurysm presented to the eye clinic with acute-onset visual loss in the same eye. The patient had a known diagnosis of hypertension and had been untreated by his primary care physician for one year. Dilated fundus examination revealed extensive multi-layered haemorrhaging along with significant macular oedema. A choroidal neovascular membrane was ruled out with fluorescein angiography. The patient was treated with monthly bevacizumab injections over a period of three months. At six months optical coherence tomography confirmed the resolution of macular oedema and the patient achieved a marked improvement in his visual acuity.Retinal arterial macroaneurysm is one of the few clinical entities with the potential to produce any combination of preretinal, intraretinal, subretinal and/or vitreal haemorrhage. When the macula is threatened, treatment must be pursued. Although laser treatment has traditionally been used, anti-vascular endothelial growth factor therapy has been used with promising visual outcomes.

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Hepatitis C virus (HCV) is a blood-borne pathogen that often results in chronic liver infection leaving patients at risk for cirrhosis, liver decompensation and hepatocellular carcinoma. The goal of therapy is to eliminate the virus in order to minimize morbidity and mortality from HCV infection. Traditional treatment has utilized a combination of pegylated-interferon (IFN) and ribavirin that often causes both systemic and ocular side effects. The most common ocular side effects are retinal hemorrhages and cotton wool spots, although in rare circumstances more significant ophthalmic adverse events have been attributed to IFN therapy. Here we discuss a case of bilateral anterior ischemic optic neuropathy (AION) that occurred during treatment with IFN and ribavirin for HCV genotype 1. We review the proposed pathogenesis of ocular side effects associated with this regimen, as well as the pathogenesis and risk factors associated with AION itself. Finally, we will offer clinical recommendations for screening for more than retinopathy should a patient present with ophthalmic complications.

Le virus de l’hépatite C (HC) est un agent pathogène à transmission hématogène qui cause souvent une infection chronique du foie et expose les patients à la cirrhose, à la décompensation hépatique et au carcinome hépatocellulaire. Le traitement vise à faire disparaître le virus afin de réduire au minimum la morbidité et la mortalité causées par l’hépatite C. Comme traitement traditionnel, on utilise une combinaison interféron pégylé (IFN) et ribavirine qui cause souvent des effets secondaires à la fois systémiques et oculaires. Les hémorragies rétiniennes et les nodules cotonneux constituent les effets secondaires oculaires les plus courants, même si l’on a attribué, dans de rares cas, des événements indésirables ophtalmiques plus importants au traitement à l’IFN. Nous discutons ici d’un cas de neuropathie optique ischémique antérieure (NOIA) bilatérale qui s’est produit au cours d’un traitement à l’IFN et à la ribavirine contre l’hépatite C de génotype 1. Nous passons en revue la pathogénèse proposée des effets secondaires oculaires de ce traitement, ainsi que la pathogénèse et les facteurs de risque associés à la NOIA même. Enfin, nous formulerons des recommandations cliniques portant sur le dépistage d’autres problèmes en sus de la rétinopathie si un patient se présente avec des complications ophtalmiques.