Anomalous Cilioretinal Artery With Associated Macroaneurysms: A Case Report and Literature Review

We present a rare case of multiple vascular macroaneurysms involving an anomalous cilioretinal artery in a hypertensive individual. A 42-year-old female presented with decreased vision in her left eye. Fundus examination and fluorescein angiography revealed bilateral Grade 2 hypertensive vasculopathic changes according to the Keith-Wagener-Barker classification, along with an anomalous cilioretinal artery characterized by an extensive branching network, extension to the far superotemporal quadrant, and macroaneurysms along its course, one of which was actively leaking with secondary macular lipid exudation in the left eye. Systemic evaluation revealed high blood pressure, and she was diagnosed with systemic hypertension and started on systemic antihypertensive medication. Treatment of the leaking macroaneurysm with focal laser photocoagulation was performed, in addition to peripheral sectoral laser, covering the ischemic temporal retina. Three intravitreal bevacizumab injections were administered without subject or objective improvement. Anomalous cilioretinal arteries associated with macroaneurysms are exceedingly rare. Our case illustrates that hypertensive vasculopathy, along with altered hemodynamic stress and overload on the abnormal vessel, may elevate the risk of macroaneurysm formation.