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The authors report two cases of retinal artery macroaneurysm (RAM) complicated with subhyaloid hemorrhage. There are multiple cases about RAM that have been published; however, none of them present all the different treatments with its benefits and its limitations. Our study highlights all aspects of treatment. RAM is an uncommon pathology that affects generally elderly women with systemic vascular pathologies. It is often unilateral, and the patients stay mostly asymptomatic. Most cases of RAM regress without any treatment. A case of a 54-year-old male, with a medical history of hypertension who presented with an acute and unilateral decreased visual acuity (VA). Initial VA was limited to counting fingers at 1 m in the right eye (RE). The anterior segment was normal in both eyes. A fundus examination in the RE showed a large subhyaloid hemorrhage associated to retinal hemorrhage. Fluorescein angiography in the RE did not reveal any sign of macroaneurysm due to blockage of fluorescein by the hemorrhage. In the left eye, there was a hyperfluorescent paramacular lesion. Optical coherence tomography showed the hyperreflectivity of the subhyaloid hemorrhage and the underlying retinal layers could not be seen. Neodymium-doped yttrium aluminum garnet laser hyaloidotomy was performed for this patient to release the trapped hemorrhage into the vitreous, 3 weeks after initial loss of vision with a good visual outcome after the treatment. An 80-year-old woman, with medical history of rheumatoid arthritis who presented with an acute loss of vision in the RE. VA in the RE was 20/200. She had a nuclear cataract in both eyes. A fundus examination showed a subyaloid hemorrhage. Fluorescein angiography in the RE revealed a hyperfluorescent structure emanating from the superotemporal arcade of the artery compatible with a macroaneurysm. The patient was treated with three intravitreal antivascular endothelial growth factor injections with poor visual outcomes. Vision loss occurs with RAM complications. They mainly involve hemorrhages and macular exudations and are usually associated with poor visual recovery. There is no established treatment for RAM and its complications. There are many options, but the optimal therapy is still unknown.
RESUMO
AIM: To analyze microcirculatory abnormalities, central avascular area and capillary density in OCT-angiography in retinal venous occlusions (RVO). METHODS: This is a descriptive study of 35 patients (35 eyes) with RVO who consulted at the ophthalmology department of Farhat Hached Hospital in Sousse between January 2014 and July 2018. The diagnosis of retinal venous occlusion was established on clinical examination, fundus photography and fluorescein angiography. All patients underwent OCT-angiography and OCT B-scan. RESULTS: Our study includes a total of 35 patients (35 eyes). Of these patients, 20 (57.1%) had branch retinal vein occlusion and 15 (42.8%) had central retinal vein occlusion. The loss or rarefaction of the capillary plexus concerned the deep capillary plexus (DCP) more than the superficial one (SCP). This rarefaction was observed in 25 eyes (71.42%) in both DCP and SCP. The widening of the central avascular zone and the rupture of the peri-foveolar anastomotic mesh were better or as visible as fluorescein angiography. Vascular tortuosity was easy to analyze and was more evident in the SCP than the DCP. Twenty-six (74.28%) patients had vascular tortuosity in DCP and 30 patients (85.71%) had this vascular tortuosity in SCP. Capillary dilatation and microaneurysms were better visible in the DCP than the SCP. These vascular abnormalities were found in 26 cases (74.28%) in the DCP and in 17 cases (48.57%) in the SCP. CONCLUSIONS: OCT-A is a non-invasive examination that allows very precise analysis and follow-up of both macular edema and superficial and deep capillary plexus architecture during retinal vein occlusions.