This 34YO female presented with a symptomatic ruptured retinal arterial macroaneurysm (RAM).
Vision was counting fingers due to the inferior sub-internal limiting membrane blood obscuring the underlying fovea. More peripherally, blood is staining the surrounding nerve fiber layer. The fibrosed RAM is visible superiorly.
Learning Points:
A RAM is thought to occur in a weakened arterial wall from arteriosclerosis, and usually appears as a yellow-white dilated lesion along a retinal arteriole within the first 3 bifurcations from the optic nerve.
There are 2 distinct presentations, hemorrhagic or exudative. The hemorrhagic type often presents with pathognomonic preretinal, intraretinal, and subretinal blood. Acute macular hemorrhage can be treated with observation, anti-VEGF injections, or thermal laser to the RAM.
