Zghal-Mokni I, Nacef L, Yazidi B, Malek I, Bouguila H, Ayed S
Institut Hedi Raies d'Ophtalmologie, Tunis, Tunisia.
J Fr Ophtalmol. 2007 Feb;30(2):150-4. doi: 10.1016/s0181-5512(07)89565-9.
Retinal arterial macroaneurysm (RAM) is an acquired vascular retinal abnormality that has developed from a retinal arterial branch located in the macular area. It is responsible for decreased visual acuity when complications such as bleeding or retinal exudation occur. A ruptured RAM leads to severe premacular, submacular, or vitreous hemorrhage. The progression can be spontaneously favorable depending on the severity and the location of the hemorrhage. A poor visual prognosis is usually reported in subretinal hemorrhage. We reported the observation of four patients with macular hemorrhage secondary to ruptured RAM.
Four patients--two males and two females, aged from 39 to 65 years, presented with sudden unilateral decreased visual acuity. An ophthalmologic exam with visual acuity measurement, anterior segment exam, ocular tonometry, and funduscopy was performed, completed with fluorescein retinal angiography. A Nd:Yag laser hyaloidotomy was done in two cases of premacular hemorrhage 1 week after its occurrence. Submacular hemorrhages were only observed using visual acuity measurement and ophthalmoscopic examination. The follow-up is 3-4 months.
Initial visual acuity varied from light perception to 2/10. The fundus examination showed a macular hemorrhage: subretinal in one case, preretinal in two cases, and in the last case the hemorrhage was both preretinal and subretinal. The diagnosis of MAR was confirmed by fluorescein angiography, which showed a hyperfluorescent arterial dilatation temporal to the macula. In the cases of submacular hemorrhage, the hemorrhage reduced spontaneously after simple monitoring. Final visual acuity was 4/10 and 5/10. For premacular subhyaloid hemorrhage treated with laser Nd:Yag drainage, the final visual acuity was 5/10 and 7/10.
Visual prognosis in premacular hemorrhage is improved by Nd:Yag laser treatment. Subretinal hemorrhage can have a spontaneous favorable outcome. Surgery should not be systematic. Comparative studies are necessary to apply indications.
视网膜动脉大动脉瘤（RAM）是一种后天性视网膜血管异常，由黄斑区的视网膜动脉分支发展而来。当发生出血或视网膜渗出等并发症时，它会导致视力下降。破裂的RAM会导致严重的黄斑前、黄斑下或玻璃体出血。根据出血的严重程度和位置，病情进展可能会自发好转。黄斑下出血通常预后较差。我们报告了4例因RAM破裂继发黄斑出血的病例观察。
4例患者，2男2女，年龄39至65岁，均表现为突然单侧视力下降。进行了包括视力测量、眼前节检查、眼压测量和眼底镜检查在内的眼科检查，并完成了荧光素视网膜血管造影。2例黄斑前出血患者在出血发生1周后接受了Nd:YAG激光玻璃体切割术。黄斑下出血仅通过视力测量和检眼镜检查观察。随访时间为3至4个月。
初始视力从光感至2/10不等。眼底检查显示黄斑出血：1例为黄斑下出血，2例为视网膜前出血，最后1例为视网膜前和黄斑下出血。荧光素血管造影证实了MAR的诊断，显示黄斑颞侧有高荧光动脉扩张。在黄斑下出血的病例中，单纯观察后出血自行吸收。最终视力分别为4/10和5/10。对于接受激光Nd:YAG引流治疗的黄斑前玻璃体下出血患者，最终视力分别为5/10和7/10。
Nd:YAG激光治疗可改善黄斑前出血的视力预后。黄斑下出血可能有自发好转的结果。不应一概而论地进行手术。需要进行对比研究以确定手术适应症。
