Retinal macroaneurysms are described as idiopathic, acquired, round dilations of major retina arterioles, usually singular and unilateral. If located at the posterior pole, they may be associated with macular exudation and hemorrhage resulting in decreased visual acuity. Systemic hypertension is the most common associated risk factor. Pathogenesis of retinal arterial macroaneurysms is not fully understood. Over time or after acute hemorrhage, spontaneous thrombosis and closure of the aneurysm may occur; in some cases, the artery may return to normal. Bleeding is a common complication of aneurysm formation and can occur beneath the retina, the retinal pigment epithelium (RPE), under the internal limiting membrane (ILM) or into the vitreous cavity.

Clinical case:

An 81 year-old man presented with sudden vision loss in the right eye (RE) to hand motion. Photopsia, metamorphopsia or new floaters were not reported. History of ocular trauma, transient ischemic attacks or neurologic symptoms were negated. Medical history revealed arterial hypertension and prostatic neoplasia. Pupillary reflexes were normal. No ophthalmologic changes were identifiable by biomicroscopic exam. Ophthalmoscopy revealed a localized preretinal hemorrhage covering macula area. A whitish lesion was also seen adjacent to the superotemporal artery, but was not well distinguishable. Five days later an extensive area of subretinal and intraretinal hemorrhage with inferior vitreous hemorrhage and a white spot along the superotemporal artery were noted. Macular OCT showed intraretinal edema and subretinal fluid (blood) without choroidal abnormalites. The fellow eye had normal findings. The patient was scheduled for combined surgery (phacoemulsification, intraocular lens implantation, pars plana vitrectomy with dye-assisted ILM peeling). Intraoperatively, a hemorrhage with subretinal and sub-ILM components were found. Two months postoperatively, the patient best corrected visual acuity has increased to 4/10. Fundus examination revealed a whitish lesion corresponding to previous location of macroaneurysm.


The clinical presentation of a retinal arterial macroaneurysm is highly variable, making initial diagnosis difficult. Early diagnosis is crucial for timely and appropriate management. Prognosis is generally good, if the macular area is spared. However, in cases with macular threat or involvement, prognosis worsens. Several treatment options are available and if vitreous and sub-ILM hemorrhage is present, surgery may be considered. Many studies suggest that in patients with submacular hemorrhage, visual prognosis is particular poor. Fortunately, the present report showes, that this is not valid for every the case.