Multi-layered haemorrhage secondary to retinal arterial macroaneurysm: a case report and review

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.