From the Guidelines
The most common cause of macroaneurysm of the retina is hypertension, as evidenced by the fact that retinal arterial macroaneurysms are a manifestation of hypertensive retinopathy, which can cause occlusion or leakage of the retinal vasculature 1. When considering the etiology of macroaneurysms, it is essential to recognize that hypertensive damage to the arterial walls is a primary factor in their development. Key characteristics of retinal arterial macroaneurysms include:
- Acquired dilations of the retinal arterioles
- Typically occur in elderly patients, particularly women
- Often associated with a history of systemic hypertension
- May also be related to other risk factors such as atherosclerosis, diabetes mellitus, and hyperlipidemia, although hypertension is the predominant cause The clinical presentation of macroaneurysms can vary, with some patients being asymptomatic and others experiencing sudden vision loss due to rupture and hemorrhage into the retina, vitreous, or subretinal space. Management strategies for macroaneurysms focus on controlling the underlying hypertension, as many lesions will spontaneously thrombose and resolve 1. In symptomatic cases with significant hemorrhage or exudation affecting the macula, additional treatments such as laser photocoagulation or anti-VEGF injections may be considered. Regular blood pressure monitoring and control are crucial for both the prevention and management of this condition, highlighting the importance of addressing hypertension as the primary cause of macroaneurysms of the retina.
From the Research
Causes of Macroaneurysm of the Retina
- The most common cause of macroaneurysm of the retina is associated with systemic hypertension, as seen in studies 2, 3, 4, 5
- Hypertension is a strong association with retinal arterial macroaneurysms, particularly in the elderly female population 3, 4
- Other factors such as arteriosclerotic vascular changes may also contribute to the development of macroaneurysms 3
Clinical Characteristics
- Macroaneurysms can present with variable clinical findings, including subretinal hemorrhage, macular exudate, and epiretinal membranes 3
- The natural history of most macroaneurysms is spontaneous involution without loss of vision, but visual loss may occur secondary to complications such as macular edema, exudate, hemorrhage, and neurosensory retinal detachment 3
Diagnosis and Treatment
- Diagnosis of retinal arterial macroaneurysms can be made using fundus fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) 2
- Treatment options include photocoagulation, intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, and observation 3, 6