This 65YO female presented with 5 days of acute vision loss in her left eye. Vision was 20/20 in her normal OD and 20/400 OS.
Color photography shows a large subretinal hemorrhage occupying the entire macula, along with a smaller preretinal hemorrhage. A somewhat fibrosed retinal arterial macroaneurysm (RAM) is noted within the preretinal blood. An intravitreal ranibizumab injection was given, but the patient was unfortunately immediately lost to follow-up.
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 or exudative. The hemorrhagic type often presents, as in this case, with pathognomonic multiple layers of blood. Acute macular exudation can be treated with observation, anti-VEGF injections, or thermal laser.
