This 85YO female presented with some peripheral vision loss in her right eye. Vision was 20/40.
Optos color imaging shows areas of subretinal blood in the inferotemporal macula and below the inferotemporal arcade, intraretinal blood, and multiple areas of inferior preretinal blood. A rim of radiating outer plexiform blood surrounds the large subretinal blood.
Fluorescein angiography shows blockage from the various layers of blood, along with leakage from the causative macroaneurysm.
We recommended initial observation due to the excellent vision and ectopic blood.
Learning Points:
A retinal arterial macroaneurysm (RAM) is thought to result from a weakened arterial wall due to arteriosclerosis. A RAM 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 preretinal, intraretinal, and subretinal blood.
Acute macular hemorrhage can be treated with observation, anti-VEGF injections, or thermal laser.
