Macroaneurysm on the Optic Disc in a Patient with Aortic Dissection

Abstract

Purpose: We report a case of macroaneurysm on the optic disc, a rare location, accompanied by vitreous hemorrhage in a patient with aortic dissection. Methods: A 60-year-old female with a history of aortic dissection at the age of 51 presented with visual disturbance owing to vitreous hemorrhage in her right eye. During vitrectomy, we found a large macroaneurysm on the optic disc that was beating and oozing blood. However, the macroaneurysm was not treated. Results: The macroaneurysm gradually shrunk, and the beating and oozing of blood disappeared accordingly. Conclusion: Up to now, there have been no reports of macroaneurysm on the optic disc in aortic dissection patients. The association between macroaneurysm on the optic disc and aortic dissection is unclear; therefore, additional case reports may be necessary. To the best of our knowledge, our case is the first one reported in the literature.

Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

“…The differential diagnosis of a mass lesion on the disc includes granulomatous inflammatory lesions such as sarcoidosis and toxoplasmosis as well as tumors such as capillary hemangioma, astrocytoma, melanocytoma, melanoma, and metastatic tumor [ 10 ]. The diagnosis of ONRAM was established in our case by its typical orange red appearance and pulsatile nature [ 9 ]. ONRAM can be symptomatic from exudation or rupture.…”

“…Compared to RAMs located outside of optic nerve, branch retinal arteriolar occlusion following rupture of an ONRAM resulting in secondary closure of distal vasculature seems to be a disproportionately common event, having been reported in 5 of 18 reported cases of ONRAMs [ 8 , 10 , 11 , 12 , 17 ]. Subhyaloid or vitreous, but not submacular, hemorrhage following rupture of ONRAMs has been reported in 8 eyes in five publications [ 6 , 7 , 8 , 9 , 18 ]. It cleared spontaneously in 3 eyes [ 6 , 7 , 18 ], while 5 eyes in three publications required vitrectomy [ 7 , 8 , 9 ].…”

“…Subhyaloid or vitreous, but not submacular, hemorrhage following rupture of ONRAMs has been reported in 8 eyes in five publications [ 6 , 7 , 8 , 9 , 18 ]. It cleared spontaneously in 3 eyes [ 6 , 7 , 18 ], while 5 eyes in three publications required vitrectomy [ 7 , 8 , 9 ]. Spontaneous involution of ONRAM occurred in each of 8 eyes with vitreous or subhyaloid hemorrhage.…”

“…ONRAMs can be an asymptomatic incidental finding [ 5 ] or can result in vitreous hemorrhage [ 6 , 7 , 8 , 9 ], branch retinal artery occlusion [ 8 , 10 , 11 , 12 ], or macular edema [ 13 , 14 , 15 , 16 ]. To our knowledge, only five eyes in three publications required pars plana vitrectomy (PPV) for vitreous hemorrhage from a ruptured ONRAM [ 7 , 8 , 9 ]. In each case, vitreous hemorrhage was a one-time event and was followed by spontaneous involution of the ONRAM without any treatment.…”

Acute Onset of Dense Vitreous Hemorrhage Associated with Retinal Arterial Macroaneurysm on the Optic Disc

“…Most common complications of RAM on the optic disc include retinal hemorrhages, retinal exudates, branch retinal artery occlusion (BRAO), and vitreous hemorrhages (VH) [ 1 , 2 , 3 , 4 , 5 ]. Although RAMs can cause VH [ 1 , 2 , 3 , 5 ], their frequency and timing of VH occurrence on the optic disc is unknown [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. To the best of our knowledge, no reports have clearly demonstrated the early onset of VH after development of RAM on the optic disc.…”