Retinal Macroaneurysm

The term Retinal macroaneurysm was coined by Robertson.  It is a retinal condition defined as an acquired, focal dilation of a retinal artery (ranging between 100 to 250 μm in diameter) occurring in the posterior fundus within the first three orders of bifurcations of the central retinal arterioles or at the level of arteriovenous crossings. The superotemporal arteriole is most commonly affected. RAM (retinal artery macroaneurysm) may be associated with systemic hypertension and cardiovascular arteriosclerotic disease.  The patient is usually asymptomatic, and a decline in visual acuity occurs due to macular edema, end-arteriole occlusion due to thrombosis, or hemorrhage caused by rupture of the aneurysm. Some lesions can resolve spontaneously by natural thrombosis; however, some require treatment.  Identifying RAM is pivotal for proper management and requires a precise approach to control the underlying systemic condition. The diagnostic modalities for identification and management include FFA (fundus fluorescein angiography), ICG-A (indocyanine green angiography), OCT (optical coherence tomography), OCT-A (optical coherence tomography angiography), and USG (ultrasonogram) B scan (brightness scan). Procedures like laser photocoagulation, intravitreal Anti VEGF (anti-vascular endothelial growth factor) agents, YAG (yttrium-aluminum-garnet) hyaloidotomy, pneumatic displacement, and pars plana vitrectomy can be used to treat complicated RAMs.