title: Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms.
abstract: OBJECTIVE
  Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined.
  
  
  METHODS
  Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation.
  
  
  RESULTS
  Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40 % showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM.
  
  
  CONCLUSIONS
  Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland. emilylhughes@gmail.com.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Hughes
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Dooley
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Kennelly
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
authors.forename: Fergus
authors.initials: F
authors.lastname: Doyle
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
authors.forename: W F
authors.initials: WF
authors.lastname: Siah
authors.affiliation: Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Connell
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D011379:Prognosis; D012161:Retinal Artery; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
keywords: Fluorescein angiography; Laser coagulation; Retinal arterial macroaneurysm; Retinal haemorrhage