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Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms

  • Retinal Disorders
  • Published:
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Abstract

Purpose

Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined.

Methods

Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation.

Results

Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40 % showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM.

Conclusion

Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.

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Authors and Affiliations

  1. Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland

    Emily L. Hughes, Ian J. Dooley, Kevin P. Kennelly, Fergus Doyle, W. F. Siah & P. Connell

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  1. Emily L. Hughes
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  2. Ian J. Dooley
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  3. Kevin P. Kennelly
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  4. Fergus Doyle
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  5. W. F. Siah
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  6. P. Connell
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Corresponding author

Correspondence to Emily L. Hughes.

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No funding was received for this research.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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For this type of study (retrospective review) formal consent is not required.

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Hughes, E.L., Dooley, I.J., Kennelly, K.P. et al. Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms. Graefes Arch Clin Exp Ophthalmol 254, 2203–2207 (2016). https://doi.org/10.1007/s00417-016-3388-9

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  • DOI: https://doi.org/10.1007/s00417-016-3388-9

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