Two suspected sequential retinal arterial macroaneurysms in a single eye with secondary nonvascular cystoid macular edema: 5-year follow-up: a case report

Retinal arterial macroaneurysm (RAM) is an acquired vascular disorder. The long-term natural history of multiple RAMs in a single eye complicated by nonvascular cystoid maculopathy (NVCM) is rarely documented.

A 65-year-old hypertensive woman presented with acute vision loss in her left eye secondary to severe vitreous hemorrhage. She underwent pars plana vitrectomy with intravitreal recombinant tissue plasminogen activator thrombolysis and silicone oil tamponade. Postoperative multimodal imaging supported the diagnosis of two suspected sequential RAMs confined to the left eye. Over a 5-year follow-up, the two lesions exhibited divergent outcomes: one developed fibrosis and persistent NVCM associated with severe initial hemorrhage and inadequate blood pressure control, whereas the other regressed completely following rigorous systemic hypertension management.

Multiple RAMs within the same eye can follow distinctly divergent natural courses. In this single case, early blood pressure control appeared to be an important contributing factor to the divergent lesion outcomes, although the contribution of spontaneous regression and other confounding factors cannot be excluded. Multimodal imaging is indispensable for differentiating NVCM from vasogenic macular edema, guiding individualized conservative management, and preventing unnecessary interventions.