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Mihai Mititelu, Jonathan Naysan, Ronni M. Lieberman; Retinal Macroaneurysms - Presentation, Comorbidities, Complications, And Management. Invest. Ophthalmol. Vis. Sci. 2012;53(14):951.
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Macroaneurysms (MA) are acquired, pathologic dilations of large retinal arterioles. They may be complicated by macular edema and hemorrhage, which in turn lead to visual loss. We investigated the impact on vision and the relationship to systemic and ocular comorbidities in a series of consecutive patients with macroaneurysms.
The medical records of patients seen on the Retina service of a large inner city eye clinic between January 2008 and September 2011 were searched for the diagnosis of MA. Ten patients (12 eyes) diagnosed with at least one retinal MA were identified, and the charts analyzed for best corrected Snellen visual acuity (BCVA) converted to logMar, location of MA, complications, laser treatment, as well as ocular and systemic comorbidities.
The cohort included six women and four men with an average age of 67.5 years (range 42 - 87 years). Nine eyes had good BCVA at presentation (defined as 20/40 or better). The right eye was more commonly affected (8 eyes), with macular involvement in 75% of the eyes. The MA was located within 2 disc diameters of the superotemporal arcade in eight eyes. Eight patients (seven with a diagnosis of hypertension) suffered complications including clinically significant macular edema (5 eyes), vitreous hemorrhage (2 eyes) and enlargement of the MA (1 eye). In three eyes, complications were diagnosed at presentation, while the remainder developed during follow-up. Out of the seven eyes that were treated with barrier laser, five were followed-up for an average of 31 months and they all maintained their initial visual acuity (20/40 or better). Ten of eleven eyes with both hypertension and MA had ocular vascular comorbidities, most importantly diabetic retinopathy and retinal vein occlusion.
This pilot study suggests that although macroaneurysms may present with good BCVA at baseline, they may be associated with significant ocular and systemic comorbidities. We noted a strong correlation with hypertension, right eye involvement and superotemporal location. Since less than half of the eyes presented with one of the potential MA complications at baseline, long term follow-up and careful attention to the presence of comorbidities and development of complications of such patients is important. The findings of this study suggest that early treatment may be useful in preserving vision, especially in eyes at risk for developing immediate complications threatening vision (clinically significant macular edema, persistent enlargement and vitreous hemorrhage).
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