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65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol. VISUAL ACUITY: OD 20/60, OS 20/30. IOP: OD 14, OS 15. SLIT EXAMINATION: The right eye has some subtle epithelial irregularities just inferior to fixation and 3+ nuclear sclerosis. The left eye has 3+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a retinal arterial macroaneurysm along the superotemporal branch retinal arterial about 2 disc-diameters superior to the fovea with a ring of fluid and hemorrhage around it. There is edema involving the fovea. OS: Vertical C/D ratio is 0.1. There are 2+ arterial venous crossing changes. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 586 microns and there is a serous foveal detachment. The left eye has a central thickness of 249 microns from a macular pucker. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows severe leakage from the retinal arterial macroaneurysm in the right eye. The left eye has a normal foveal appearance and minimal arterial venous crossing changes. IMPRESSION: 1. RETINAL ARTERIAL MACROANEURYSM – RIGHT EYE 2. MACULAR EDEMA – RIGHT EYE 3. MACULAR HEMORRHAGE – RIGHT EYE 4. MACULAR PUCKER – LEFT EYE 5. CATARACT DISCUSSION: I explained to the patient with laser there is a chance of drying up the retinal arterial macroaneurysm and preventing vision loss. I warned her though with or without laser, there is a risk of rupture as well as a risk of branch retinal arterial occlusion in the area of the retinal arterial macroaneurysm. We talked about the risks, benefits, indications, and alternatives of focal laser photocoagulation and the patient agreed to this procedure after the questions were answered. Focal laser photocoagulation was performed today without any difficulty. I used the yellow laser, a large spot and a long duration and I asked her to return for a check in one month. Visit 2 - 2 months later: March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200 Visit 3 - 4 months post laser: on May 23, 2011. This pleasant 66-year-old woman had a leaky arterial macroaneurysm I lasered in January. She developed more swelling subsequently, but an angiogram showed the lesion was closed. Since then she has noticed her vision poor in the eye. VISUAL ACUITY: OD 20/200 Follow-up Rupture: July 18, 2011. This pleasant 66-year-old woman has a retinal arterial macroaneurysm. She had focal laser January 12th. Her vision had improved, but then three weeks ago it worsened again. She is not on any blood thinners. She wasn’t doing any heavy lifting or straining. VISUAL ACUITY: OD 3/200. IOP: 11. There is 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a macular hemorrhage. The hemorrhage in the very center of the macula is about 2 disc-diameters across and then there is boat shaped hemorrhages inferiorly, one which looks to be under the internal limiting membrane and the other which looks to be under the posterior hyaloid. Photos confirm clinical findings. Photos confirm clinical findings. IMPRESSION: 1. RECURRENT HEMORRHAGE FROM A RETINAL ARTERIAL MACROANEURYSM DISCUSSION: I explained to the patient unfortunately the aneurysm has rebled. There is excellent evidence that once they rebleed like this they tend to self seal and I don’t think further laser treatment would improve her course. I told her that there is probably a 50/50 chance her vision will improve, but it is probably going to take about three to six months and I did tell her that the vision rarely improves to normal after a hemorrhage like this. I asked her to return here for a check in three months or sooner if she should notice a problem.

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 363 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 241 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 179 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 189 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 157 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 153 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 155 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 252 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 131 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 98 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
44444
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 112 views65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol.

VISUAL ACUITY: OD 20/60
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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 146 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 141 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 131 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 143 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 152 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 168 viewsVisit 2 - 2 months later:
March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Increased Swelling after Laser 248 viewsVisit 3 - 4 months post laser:
on May 23, 2011. This pleasant 66-year-old woman had a leaky arterial macroaneurysm I lasered in January. She developed more swelling subsequently, but an angiogram showed the lesion was closed. Since then she has noticed her vision poor in the eye.

VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Recurrent Hemorrhage 6 months post laser470 views6 months post laser: Her vision had improved, but then three weeks ago it worsened again. She is not on any blood thinners. She wasn’t doing any heavy lifting or straining.

VISUAL ACUITY: OD 3/200
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Retinal Arterial Macroaneurysm - Recurrent Hemorrhage 6 months post laser235 views6 months post laser: Her vision had improved, but then three weeks ago it worsened again. She is not on any blood thinners. She wasn’t doing any heavy lifting or straining.

VISUAL ACUITY: OD 3/200
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65-year-old woman was seen in the office on January 12, 2011. She has noticed decreased vision in the right eye for the last two or three weeks. She has had some discomfort in both eyes as well. She has a history of low blood pressure, but she does have high cholesterol. VISUAL ACUITY: OD 20/60, OS 20/30. IOP: OD 14, OS 15. SLIT EXAMINATION: The right eye has some subtle epithelial irregularities just inferior to fixation and 3+ nuclear sclerosis. The left eye has 3+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a retinal arterial macroaneurysm along the superotemporal branch retinal arterial about 2 disc-diameters superior to the fovea with a ring of fluid and hemorrhage around it. There is edema involving the fovea. OS: Vertical C/D ratio is 0.1. There are 2+ arterial venous crossing changes. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 586 microns and there is a serous foveal detachment. The left eye has a central thickness of 249 microns from a macular pucker. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows severe leakage from the retinal arterial macroaneurysm in the right eye. The left eye has a normal foveal appearance and minimal arterial venous crossing changes. IMPRESSION: 1. RETINAL ARTERIAL MACROANEURYSM – RIGHT EYE 2. MACULAR EDEMA – RIGHT EYE 3. MACULAR HEMORRHAGE – RIGHT EYE 4. MACULAR PUCKER – LEFT EYE 5. CATARACT DISCUSSION: I explained to the patient with laser there is a chance of drying up the retinal arterial macroaneurysm and preventing vision loss. I warned her though with or without laser, there is a risk of rupture as well as a risk of branch retinal arterial occlusion in the area of the retinal arterial macroaneurysm. We talked about the risks, benefits, indications, and alternatives of focal laser photocoagulation and the patient agreed to this procedure after the questions were answered. Focal laser photocoagulation was performed today without any difficulty. I used the yellow laser, a large spot and a long duration and I asked her to return for a check in one month. Visit 2 - 2 months later: March 21, 2011. This pleasant 66-year-old woman had laser to retinal arterial microaneurysm in the right eye January 12th. Her vision was getting better, but now it is worse the last few days. She is at home taking care of her demented mother and she and her sister lift her mother a fare amount of the time. I also checked her blood pressure, which was 120/65. VISUAL ACUITY: OD 20/200 Visit 3 - 4 months post laser: on May 23, 2011. This pleasant 66-year-old woman had a leaky arterial macroaneurysm I lasered in January. She developed more swelling subsequently, but an angiogram showed the lesion was closed. Since then she has noticed her vision poor in the eye. VISUAL ACUITY: OD 20/200 Follow-up Rupture: July 18, 2011. This pleasant 66-year-old woman has a retinal arterial macroaneurysm. She had focal laser January 12th. Her vision had improved, but then three weeks ago it worsened again. She is not on any blood thinners. She wasn’t doing any heavy lifting or straining. VISUAL ACUITY: OD 3/200. IOP: 11. There is 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a macular hemorrhage. The hemorrhage in the very center of the macula is about 2 disc-diameters across and then there is boat shaped hemorrhages inferiorly, one which looks to be under the internal limiting membrane and the other which looks to be under the posterior hyaloid. Photos confirm clinical findings. Photos confirm clinical findings. IMPRESSION: 1. RECURRENT HEMORRHAGE FROM A RETINAL ARTERIAL MACROANEURYSM DISCUSSION: I explained to the patient unfortunately the aneurysm has rebled. There is excellent evidence that once they rebleed like this they tend to self seal and I don’t think further laser treatment would improve her course. I told her that there is probably a 50/50 chance her vision will improve, but it is probably going to take about three to six months and I did tell her that the vision rarely improves to normal after a hemorrhage like this. I asked her to return here for a check in three months or sooner if she should notice a problem.