Optic nerve head retinal artery macroaneurysm: Report of a case

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.