A Rare Case Of Retinal Arterial Microaneurysm: Clinical Features And Diagnostic Insights

Authors

  • Uray Nabila Yuna Universitas Padjajaran
  • Grimaldi Ihsan Widyanatha Universitas Padjajaran
  • Rova Virgana Universitas Padjajaran
  • Arief S. Kartasasmita Universitas Padjajaran
  • Erwin Iskandar Universitas Padjajaran
  • Made Indra Widyanatha Universitas Padjajaran

DOI:

https://doi.org/10.26911/theijmed.2025.10.01.02

Abstract

Background: In Retinal Arterial Macroaneurysms (RAM), the central retinal artery suffers from acquired focal hypertension. Clinical manifestations of the disease are diverse and easily misdiagnosed. Several imaging modalities may be used in order to confirm the diagnosis of RAM. This article aims to describe the clinical features and method of diagnosis of an uncommon case of retinal artery microaneurysm.


Case report: A 57-year-old woman presented with a progressive loss of vision in her right eye months prior. Visual acuity in the right eye was 0.8 log 13. Upon funduscopic inspection of the right eye, firm exudates with low tortuosity and submacular hemorrhage were observed. The right eye’s OCTA revealed a localized expansion and significant constriction with twisted blood vessels on the reverse side of the deformed vessel, while the OCT of the macula revealed submacular hemorrhage. The patient was diagnosed with ruptured retinal Arterial Macroaneurysm or Macular Telangiectasia Type I and Retinopathy Hypertensive Grade II of both eyes, No Diabetic Retinopathy of both eyes with Diabetes Mellitus and Hypertension. The right eye of the patient received concentrated laser photocoagulation and an intravitreal injection of anti-VEGF.


Conclusion: RAM is an acquired vascular disease defined by restricted, fusiform, or saccular dilation in the first three arteries of the main retinal artery. Retinal microaneurysms can be diagnosed with various imaging modalities. Ram may be treated with intravitreal anti-VEGF drugs, combination therapy, or laser photocoagulation.

Keywords:

Retinal arterial microaneurysm, clinical characteristic, diagnostic approach, systemic hypertension

References

Chen H, Zhao XY, Meng LH, Zhang WF, Chen YX (2022). Clinical characteris-tics of retinal arterial macroaneurys-ms and prognosis of different inter-ventions. Graefes Arch Clin Exp Ophthalmol. 260(2): 439–450. Doi: 10.1007/s00417-021-05364-0.

Chen YY, Lin LY, Chang PY, Chen FT, Mai ELC, Wang JK (2017). Laser and anti-vascular endothelial growth factor agent treatments for retinal arterial macroaneurysm. Asia Pac J Ophthalmol (Phila). 6(5): 444–449. Doi: 10.22608/APO.201766.

Doi S, Kimura S, Saito S, Inoue M, Sakurai T, Kobori A, Hisatomi T et al (2023). Impact of macular intraretinal hemorrhage and macular hole on the visual prognosis of submacular hemorrhage due to retinal arterial macroaneurysm rupture. Retina. 43(4): 585–593. Doi: 10.1097/-iae.0000000000003725.

Erol MK, Dogan B, Coban DT, Toslak D, Cengiz A, Ozel D (2015). Intravitreal ranibizumab therapy for retinal arte-rial macroaneurysm. Int J Clin Exp Med. 8(7): 11572–11578. https://-www.ncbi.-nlm.nih.gov/pmc/articles/-PMC4565367/.

Goldhagen BE, Goldhardt R (2019). Retinal arterial macroaneurysms: updating your memory on ram management. Curr Ophthalmol Rep. 7(2): 73–79. Doi:10.1007/s40135-019-00202-3.

Huang Y, Zheng WW, Li YZ, Sun ZH, Lin B (2023). Retinal laser photocoagula-tion and intravitreal injection of anti-VEGF for hemorrhagic retinal arterial microaneurysm. Int J Ophthalmol. 16(12): 2041–2048. Doi:10.18240/ijo.2023.12.17.

Kim JH, Kim JW, Kim GC, Lew YJ, Cho HJ (2021). Influence of bevacizumab therapy and intraretinal hemorrhage in long-term outcomes of hemor-rhagic retinal arterial macroaneu-rysm. Scientific Reports. 11(1): 1–10. Doi: 10.1038/s41598-021-93811-7.

Liu S, Wang Y (2023). Effect of laser panretinal photocoagulation com-bined with lucentis on long-term visual acuity of patients with retinal arterial macroaneurysm. Altern Ther Health Med. 29(8): 412–417. https://pubmed.ncbi.nlm.-nih.gov/37632971/

Meng Y, Xu Y, Li L, He L, Yi Z, Chen C (2022). Retinal arterial macroaneu-rysm rupture by Valsalva maneuver: A case report and literature review. BMC Ophthalmol. 22(1): 1–10. Doi: 10.1186/s12886-022-02662-x.

Muacevic A, Adler JR (2022). Multilayered hemorrhage secondary to retinal arterial macroaneurysm rupture: A case report and review of literature. Cureus: J Med Sci. 14(4). Doi: 10.77-59/cureus.23903.

Song Y, Zhang W, Yu S, Gong Y (2023). Appearance of retinal arterial macro-aneurysms in patients using swept-source optical coherence tomographic angiography. BMC Ophthalmology, 23(1): 1–7. Doi:10.1186/s12886-023-03016-x.

Speilburg AM Klemencic SA (2014). Ruptured retinal arterial macro-aneurysm: Diagnosis and manage-men. J Optom. 7(3): 131–137. Doi: 10.1016/j.optom.2013.08.002.

Wang Y, Du H, Zhao X, Meng L, Chen Y (2022). Observation, laser photocoa-gulation or anti-VEGF therapy in the management of retinal arterial macroaneurysms. BMC Ophthalmology. 22(1): 1–9. Doi:10.1186/s12886-022-02641-2

Xie P, Feng W, Yan R, Zhu S, Gao X (2023). Hemorrhagic retinal arterial macroaneurysm combined with branch retinal artery occlusion treated with intravitreal conbercept injection: A case report. Medicine (Baltimore). 102(43):E35434. Doi: 10.1097/MD.0000000000035434.

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Published

2025-01-10

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