Retinal Arterial Macroaneurysms: Clinical Features, Management, and Outcomes

To describe baseline characteristics, management patterns, and long-term outcomes in a contemporary cohort of eyes with retinal arterial macroaneurysms (RAM) managed with observation versus treatment.

Retrospective cohort study.

Adult patients (aged ≥18 years) diagnosed with RAM at Bascom Palmer Eye Institute between January 2013 and December 2025.

Baseline demographics, ocular findings, ancillary optical coherence tomography imaging, treatments, and visual outcomes were recorded. Continuous variables were compared using two-tailed Student t-tests and Wilcoxon signed-rank tests, as appropriate. Categorical variables were compared using chi-square or Fisher exact tests. Statistical significance was defined as P < 0.05.

Resolution of RAM, time to resolution, and changes in best-corrected visual acuity (BCVA) at final follow-up.

A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years (range 19-97), and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 110 eyes (68%) were managed with observation, and 51 eyes (32%) were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50, P < 0.0001) and more frequently reported macula-involving hemorrhage (78% vs. 52%; P = 0.0024) at the initial visit. In the observation cohort, 6% of eyes developed symptomatic hemorrhage prompting treatment, which occurred an average of 250 days after the initial diagnosis. In the treatment cohort, 59% of eyes were treated with antivascular endothelial growth factor monotherapy, 22% were treated with focal laser monotherapy, 16% were treated with combination therapy, and 4% were treated with vitrectomy with tissue plasminogen activator. Resolution of RAM, defined as fibrosis of the RAM with resorption of surrounding hemorrhage and/or edema, occurred in 100% of eyes in both cohorts of patients. BCVA at last follow-up was not statistically different between groups (20/50 observation vs. 20/70 treatment, P = 0.0730). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days; P = 0.0170).

This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously; however, selective treatment of eyes with more severe initial presentation may be beneficial.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.