Ruptured Retinal Arterial Macroaneurysm on the Optic Disk

Rahimy, Ehsan; Doyle, Brian C.; Brown, Gary C.

doi:10.1097/icb.0000000000000275

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…ONH RAMs are usually associated with vascular occlusions, 7 anomalous retinal vasculature, 8 abnormal cilioretinal artery, and Sneddon’s syndrome. 9 A case of ONH RAM with secondary rupture leading to multi-layered haemorrhages in the retina was reported by Rahimy et al 10 FA should be done to confirm the diagnosis, although dense haemorrhage can block fluorescence enough to obscure the macroaneurysm. In such cases, the use of indocyanine green angiography allows visualization of the macroaneursym through haemorrhage.…”

Section: Discussionmentioning

confidence: 98%

Optic nerve head retinal artery macroaneurysm: Report of a case

Venkatesh

Gurav

2019

SAGE Open Medical Case Reports

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A 61-year-old elderly male, hypertensive patient presented to the retina clinic with sudden drop in vision in the left eye for 6 days. His best-corrected visual acuity at presentation was counting fingers close to face. Fundus examination of the left eye revealed the presence of subretinal and preretinal haemorrhage at the macula along with hypertensive retinopathy changes in both eyes. Fluorescein angiography was done, which showed a retinal artery macroaneurysm at the optic nerve head. Optical coherence tomogram through the optic nerve head also confirmed the presence of retinal artery macroaneurysm. The patient was treated with injection of 0.4 cc of 100% C3F8 to displace the blood off the macula. At final follow-up visit at 2 months post treatment, his vision improved to 6/12, N8. Fundus examination showed a small residual altered blood nasal to the fovea. No treatment was however done to the retinal artery macroaneurysm due to its atypical location and chance of spontaneous involution. In conclusion, retinal artery macroaneurysm at the optic disc is extremely uncommon. Identification of the retinal artery macroaneurysm lesion is more difficult in glaucoma patients due to the large and deep optic cup. Fluorescein angiography remains the main investigative modality to confirm the diagnosis. Spontaneous involution still remains the mainstay of treatment in optic disc retinal artery macroaneurysm.

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Section: Discussionmentioning

confidence: 98%

Optic nerve head retinal artery macroaneurysm: Report of a case

Venkatesh

Gurav

2019

SAGE Open Medical Case Reports

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“…However, RAMs on the optic disc mostly involute without any intervention and treatment is only required for symptomatic and complicated cases. 7 …”

Section: Discussionmentioning

confidence: 99%

“… 5 None of those cases were associated with the optic disc. Rahimy et al 7 described multimodal imaging findings including SD-OCT of a case of ruptured macroaneurysm on the disc with thrombosis. Nagai et al reported a case of optic disc macroaneurysm treated with posterior subtenon's kenalog injection with pre- and post-treatment SD-OCT images.…”

Section: Discussionmentioning

confidence: 99%

Arterial macroaneurysm of the optic disc

Özgönül

Besirli

2018

American Journal of Ophthalmology Case Reports

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PurposeWe present fundus and spectral domain optical coherence tomography findings of a patient with an arterial macroaneurysm of the optic disc.ObservationsAn 87-year-old woman presented with blurry vision and was found to have a retinal arterial macroaneurysm on the optic disc. Spectral domain optical coherence tomography revealed abnormal saccular arterial dilatation on the disc with an elongation anteriorly and superficial prepapillary hemorrhages. After 2 months, aneurysm thrombosed spontaneously without any visual consequences.Conclusions and importanceSpectral domain optical coherence tomography can be used for the diagnosis and follow up of optic disc arterial macroaneurysms. Our case documents the natural history and unique spectral domain optical coherence tomography appearance of an optic disc arterial macroaneurysm.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

Yang

Kishore

2017

Case Rep Ophthalmol

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Objective: To report a case of recurrent vitreous hemorrhage from an optic nerve retinal arterial macroaneurysm (ONRAM) successfully treated with intraoperative endolaser. Patient and Methods: A 92-year-old woman on oral aspirin and warfarin anticoagulation for atrial fibrillation developed three episodes of dense vitreous hemorrhage from an ONRAM. Due to failure of the vitreous hemorrhage to clear spontaneously, a total of three pars plana vitrectomy (PPV) procedures were performed along with a 1.25-mg intravitreal bevacizumab injection after the third episode of hemorrhage. During the third PPV procedure, a 25-gauge 532-nm green diode laser endoprobe was used to deliver low-power (100 mW) and long-duration (500 ms) laser spots directly on the ONRAM to induce intraoperative shrinkage of the ONRAM. Results: After the endolaser treatment, the macroaneurysm showed involution due to fibrosis without any adverse effects on retinal circulation or visual field defect. No recurrence of vitreous hemorrhage was noted after 2 years of follow-up. Conclusion: Oral anticoagulant use may have been responsible for the atypical clinical course in our patient. Laser photocoagulation, including intraoperative endolaser photocoagulation, may be considered in selected cases of symptomatic ONRAMs.

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Ruptured Retinal Arterial Macroaneurysm on the Optic Disk

Abstract: Detection of optic disk macroaneurysms at the time of initial presentation can be difficult because of concurrent overlying hemorrhage, but should nevertheless be kept in the differential when macular hemorrhage in multiple retinal layers is observed.

Cited by 6 publications

References 14 publications

Optic nerve head retinal artery macroaneurysm: Report of a case

Optic nerve head retinal artery macroaneurysm: Report of a case

Arterial macroaneurysm of the optic disc

Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

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