This 68YO female presented with acute vision loss in her left eye. Vision was hand motion from submacular blood.
A retinal arterial macroaneurysm (RAM) is noted overlying the blood, with an additional RAM with lipid more temporally.
Triton swept-source OCT scanning shows subretinal blood beneath the RAM. Fluorescein angiography shows blockage from the subretinal and intraretinal blood, with leakage from both lesions. These multiple layers of blood (subretinal and intraretinal) are classic for RAMs.
In this case, the patient elected for treatment with anti-VEGF injections.
Learning Points:
RAMs present with either acute blood or with chronic exudation, and this case is unique in that we can see both presentations in the same eye.
Acute macular hemorrhage can be treated with observation, anti-VEGF injections, or thermal laser. Macular edema with lipid exudate that threatens or involves the macular center usually requires either thermal laser treatment or anti-VEGF injections.
