From the Guidelines
Retinal macroaneurysms are primarily caused by hypertension, which damages the retinal arteriole walls and leads to focal outpouchings or dilations, as supported by the most recent evidence from 1. The development of retinal macroaneurysms is a complex process involving multiple factors, including:
- Hypertension: The primary cause of retinal macroaneurysms, which damages the retinal arteriole walls and leads to focal outpouchings or dilations 1.
- Atherosclerosis: Contributes to the development of retinal macroaneurysms by compromising vascular integrity 1.
- Aging: Increases the risk of developing retinal macroaneurysms, with women over the age of 60 being more commonly affected 1.
- Systemic vascular diseases: Play a role in the development of retinal macroaneurysms by further compromising vascular integrity 1.
- Diabetes mellitus: May also contribute to the development of retinal macroaneurysms by further compromising vascular integrity 1.
The underlying mechanism involves weakening of the arterial wall due to chronic hypertensive damage, leading to the formation of these aneurysmal dilations typically at arterial bifurcations or areas of arteriovenous crossing. Proper blood pressure control is essential for prevention and management, as uncontrolled hypertension can lead to rupture of these macroaneurysms, causing vision-threatening hemorrhages and macular edema. Regular eye examinations are important for individuals with hypertension to detect these lesions early, as supported by the evidence from 1.
From the Research
Causes of Retinal Macronaneurysm
- Retinal arterial macroaneurysms are associated with systemic vascular conditions such as hypertension and arteriosclerotic disease, occurring most commonly in elderly women 2
- Hypertension is a significant risk factor for retinal vein occlusion, which is related to retinal arterial macroaneurysms 3, 4, 5
- Other risk factors for retinal arterial macroaneurysms include female sex, retinal vein occlusions, and decreased visual acuity 3
- Systemic conditions like diabetes mellitus, hyperlipidemia, vascular cerebral stroke, blood hyperviscosity, and thrombophilia may also contribute to the development of retinal arterial macroaneurysms 4
- The metabolic syndrome, which includes hypertension, diabetes mellitus, and hyperlipidemia, is a strong risk factor for retinal vein occlusion and may also be related to retinal arterial macroaneurysms 4, 5
Risk Factors
- Advancing age is a basic risk factor for retinal vein occlusion and may also be related to retinal arterial macroaneurysms 4
- Socioeconomic status and ethnicity may also play a role in the development of retinal arterial macroaneurysms, with American blacks being more often diagnosed with retinal vein occlusion than non-Hispanic whites 4
- Cigarette smoking and systemic inflammatory conditions like vasculitis and Behcet disease may also increase the risk of retinal arterial macroaneurysms 4
- Ocular risk factors for retinal arterial macroaneurysms include ocular hypertension and glaucoma, higher ocular perfusion pressure, and changes in the retinal arteries 4