Retinal Arterial Macroaneurysms: Updating Your Memory on RAM Management

  • Brian Evan GoldhagenEmail author
  • Raquel Goldhardt
Retina (R Goldhardt, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Retina


Purpose of Review

This is a comprehensive review of management options for retinal arterial macroaneurysms (RAMs). Although close observation is typically recommended for RAMs not involving or threatening the macula, other treatment modalities can be considered for exudative or hemorrhagic complications that are vision-threatening.

Recent Findings

New imaging technologies like optical coherence tomography angiography (OCT-A) have been able to detect RAMs without the need of dye injection, further elucidating our understanding of blood flow within and around them. Observation alone is usually an adequate treatment when a lesion is not threatening the fovea. Laser photocoagulation and intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors have effectively been used for management of exudative RAMs, whereas options including injection of VEGF inhibitors, tissue plasminogen activator (tPA), vitrectomy, gas, and yttrium aluminum garnet (YAG) laser have been used for hemorrhagic RAMs.


To date, there is no consensus regarding management of symptomatic exudative or hemorrhagic complications of RAM. Additionally, a case report is presented within this paper to illustrate the successful treatment of a hemorrhagic RAM in a symptomatic 65-year-old man using intravitreal bevacizumab.


Retinal artery macroaneurysm Macroaneurysms Bevacizumab VEGF Laser Photocoagulation 


Financial Support

Supported by the NIH Center Core Grant P30EY014801, and Research to Prevent Blindness Unrestricted Grant.

Compliance with Ethical Standards

Conflict of Interest

Brian Evan Goldhagen reports grants from NIH Center Core Grant P30EY014801 and grants from Research to Prevent Blindness Unrestricted Grant during the conduct of the study. Raquel Goldhardt declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Miami Veterans Administration Medical CenterMiamiUSA
  2. 2.Bascom Palmer Eye Institute, Department of OphthalmologyUniversity of Miami Miller School of MedicineMiamiUSA

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