This 59YO female presented with acute vision loss in her left eye. Vision was counting fingers.
Optos color RGB shows a multi-layered macular hemorrhage, including preretinal, intraretinal, and subretinal blood. The causative ruptured retinal arterial macroaneurysm (RAM) is noted within the preretinal blood inferonasally. The surrounding neurosensory retina is somewhat opaque from a secondary inferior branch retinal artery occlusion (BRAO).
Optos RG color imaging shows some periarterial sparing along the superotemporal edge of the BRAO. The perfused superior retinal arteriole, as it enters the region of the occlusion, still has some oxygen that is diffusing into the perivascular tissue.
The patient was treated with several monthly Avastin injections in hopes of more rapidly resolving the surrounding fluid to help relieve arterial compression. Although the blood and fluid resolved, secondary central and inferotemporal macular atrophy resulted from the prior BRAO. Vision was 20/400.
Learning Points:
A BRAO can be a rare complication of direct thermal laser of a RAM (Russell and Folk, AJO 1987;104:186-187), which is one reason it is almost never performed anymore. In this case, we believe the BRAO was secondary to mechanical arterial compression from the surrounding blood.
