This 85 YO female presented with a retinal arterial macroaneurysm (RAM) with counting fingers vision.
The macroaneurysm has ruptured, causing multiple levels of blood shown on fundus photography and fluorescein angiography. The blood is subretinal superiorly, subhyaloid more centrally, and in the vitreous (both red and devitalized). We are observing this patient.
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 arterial within the first 3 bifurcations from the optic nerve.
There are 2 distinct presentations, hemorrhagic or 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.
