Laser Treatment of Retinal Artery Macroaneurysm

A 66-year-old man came for routine ophthalmic examination. He was a known case of type 2 diabetes mellitus for 10 years and hypertension for eight years on treatment. He had undergone YAG laser peripheral iridotomy (PI) for shallow angles in both eyes (OU) five years ago. On examination, his visual acuity was 6 / 6 in OU. His intraocular pressure was normal in OU. Anterior segment examination revealed patent PI and nuclear sclerosis grade 1 in OU. Dilated fundus examination showed mild non-proliferative diabetic retinopathy changes in OU. In the left eye (OS), pre-retinal haemorrhage, with a focal dilatation along the retinal arteriole superior to the disc, was noted [Figure 1a]. Optical coherence tomography of the macula was normal in OU. Fundus fluorescein angiogram showed small outpouching of retinal arteriole superiorly with capillary non-perfusion (CNP) areas and collaterals were noted [Figure 2a-c]. Background diabetic retinopathy changes were also seen in OU in FFA. A diagnosis of retinal artery macroaneurysm (RAM) was made. Focal laser to the RAM lesions with pan-retinal photocoagulation of the CNP areas was done [Figure 1b]. Fundus examination at six-month follow-up revealed healed laser marks with a resolution of the RAM lesion [Figure 1c].Figure 1: (a) Colour fundus photograph of the left eye showing RAM (white arrow) in the superior quadrant. (b) showing lasered RAM (white arrow) and surrounding PRP marks. (c) showing healed laser scars and regressed RAMFigure 2: Fundus fluorescein angiogram showing RAM with surrounding leakage and CNP areas in the early (a) and late (b and c) stagesRetinal artery macroaneurysm is an acquired dilatation of the retinal arteriole commonly associated with systemic hypertension.[1] Focal ischemia of the vessel wall leads to increased permeability and collagen remodelling of the inner vessel wall, resulting in a fusiform or saccular outpouching.[2] A diagnosis may be clinical or may be aided by ancillary investigations, like fluorescein angiogram, optical coherence tomography, and optical coherence tomography angiography.[3] Treatment is recommended for RAMs with haemorrhagic or exudative manifestations compromising vision and non-resolving lesions.[4] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.