This 78YO female presented with sudden blurred vision in her left eye. Vision was 20/40.
MultiColor SLO imaging shows subretinal, intraretinal and preretinal blood centered in the inferotemporal macula. A fibrosed retinal arterial macroaneurysm is seen along the inferior edge of the premacular blood. OCT shows a complex laminated pattern of subretinal and intraretinal blood.
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.
Our patient was treated with a combination of an anti-VEGF injection followed by thermal laser. Five weeks later, vision improved to 20/30 with marked improvement in the blood and macular thickening.
