This 65YO female presented with 2 weeks of paracentral vision loss in her left eye. Vision was 20/25.
Optos color RGB imaging shows multilayered hemorrhages in the nasal and superior macula, including preretinal and subretinal blood.
Swept-source OCT through the preretinal and subretinal areas confirms the locations of the blood. Fluorescein angiography shows a blockage in the blood. The retinal arterial macroaneurysm, which is noted as a yellowish mass within the superior blood clinically, is obscured by the blood angiographically.
Learning Points:
A RAM is thought to occur in a weakened arterial wall from arteriosclerosis, and appears as a yellow-white dilated lesion along a retinal artery within the first 3 bifurcations from the optic nerve.
There are 2 distinct presentations, hemorrhagic and exudative. The hemorrhagic type often presents, as in this case, with pathognomonic multiple layers of blood. Acute macular hemorrhage can be treated with observation, anti-VEGF injections, or thermal laser.
