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This 88YO female has been followed for a stable untreated branch retinal vein occlusion (BRVO) in her right eye. Vision is 20/50.
Triton color photography shows a few retinal hemorrhages and telangiectatic vessels in the superior macula. A retinal venous macroaneurysm is in the superonasal fovea, which occupies nearly full-thickness retina on swept-source OCT.
Learning Points:
In 1990, Cousins et al reported that RVMs can be an additional finding in occlusive venous disease, always in association with collateral vessels or capillary or arterial macroaneurysms (AJO 1990;109:567-570). These vascular abnormalities are often associated with intraretinal lipid (40%) but are less likely to affect central vision since they are usually outside the macula. They tend to have a higher association with retinal ischemia, thus being at a higher rate for developing retinal neovascularization (32%). Continued observation was recommended for our patient.
The terminology for these lesions, which also include retinal capillary macroaneurysms, large retinal capillary aneurysms, telangiectatic capillaries (TelCaps), and perifoveal exudative vascular anomalous complex (PEVAC), is still in flux (Forte et al, Survey Ophthalmology 2025;70:369-379). In general, the term PEVAC is reserved for idiopathic lesions, while the other terms are used for vascular abnormalities secondary to other disorders, including BRVO and diabetes.
Ophthalmol Retina. 2026 Aug;10(8):801-812. doi: 10.1016/j.oret.2026.04.005.
Pediatric macular holes: PPV high visual and anatomic success. Many also spontaneously resolve without surgery. Recommend individualized approach — Retrospective, IRIS registry.
Purpose: To compare visual outcomes, recovery trajectories, and complication rates between surgical and observational management of pediatric macular hole (MH) using a large national registry.
Design: Retrospective cohort study.
Subjects: Children younger than 18 years diagnosed with MH-related pathology between January 2013 and October 2024 in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight), with a minimum of 6 months of follow-up.
Methods: Eyes were categorized as surgical if they underwent pars plana vitrectomy with or without internal limiting membrane or epiretinal membrane peeling, or observational if managed without surgery. Best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution) was assessed longitudinally for up to 2 years. Visual acuity trajectories were modeled using generalized estimating equations, and multivariable mixed-effects logistic regression was used to identify predictors of surgical intervention.
Main outcome measures: Longitudinal BCVA, time to maximal BCVA, magnitude of visual acuity improvement, postoperative complications, and predictors of surgical management.
Results: A total of 1261 patients (1390 eyes; median age, 14 years; 62% male) were included; 254 patients (20.1%) underwent surgery, and 1007 (79.9%) were observed. Surgical eyes presented with worse baseline BCVA than observed eyes (median, 0.80 vs. 0.40 logarithm of the minimum angle of resolution; P < 0.001). Both cohorts demonstrated significant visual improvement over time (P < 0.001), with parallel improvement trajectories. Surgical eyes achieved greater median improvement from baseline to maximal BCVA (-0.40 vs. -0.12 logarithm of the minimum angle of resolution; P < 0.001) and reached maximal vision sooner (median, 0.75 vs. 1.30 years; P < 0.001). Among surgical eyes, 83.5% experienced no postoperative complications; repeat MH surgery occurred in 10.6%, cataract surgery in 4.3%, retinal detachment repair in 1.6%, and no cases of endophthalmitis were observed. Worse baseline visual acuity was the only independent predictor of surgical intervention.
Conclusions: In this large registry-based study of pediatric MH management, surgical repair was associated with rapid, sustained, and clinically meaningful visual improvement with low complication rates. Nonsurgical management also yielded spontaneous clinically significant visual improvement. These findings support an individualized approach to pediatric MH management that takes into consideration baseline anatomic and visual severity, recovery trajectory, and surgical risk.
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