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90-year-old woman has vision loss in the right eye for 6 weeks. She noticed a sudden change in vision. She is no longer able to read fine print. I saw her back in March of 2007. Back then the vision in the right eye was 20/30 and the left eye was 20/60 from a mild macular pucker. She was injured in the left eye from a potted plant back in 2007. VISUAL ACUITY: OD 8/200, OS 20/50. IOP: 20 OU. The right eye has a peripheral iridotomy and a posterior chamber intraocular lens in good position with open capsule. The left eye has a anterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There is posterior vitreous separation. There is a retinal arterial macroaneurysm inferotemporally in the right eye. There is edema in the fovea. There is atrophy inferotemporally. OS: Vertical C/D ratio is 0.0. There is posterior vitreous separation and 1+ epiretinal membrane. OCT SCAN: The OCT scan of the right eye shows an average central foveal thickness of 482 microns with a volume of 10.08 mm3. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a hyperfluorescence macroaneurysm just inferior to the fovea. In the late frames there is no evidence of any leakage. There is a ring of hypofluorescence around it from the hemorrhage. The left eye is angiographically normal. IMPRESSION: 1. MILD MACULAR PUCKER – LEFT EYE 2. RUPTURED AND SELF SEALED RETINAL ARTERIAL MACROANEURYSM – RIGHT EYE 3. MACULAR EDEMA – RIGHT EYE DISCUSSION: I explained to the patient all the testing suggest that the macroaneurysm has sealed itself. There is evidence from research studies that once these bleed they do tend to self seal and then often the vision improves without any need for therapy. It is possible to treat those with laser, but laser carries a risk of both popping the macroaneurysm causing more bleeding and also causing a distal branch retinal artery occlusion. I asked her to return for a check in three weeks. If at that time the macula is a little better, I will leave the eye alone, if it is the same or worse, I will probably consider laser to. 6 Month Follow-up 91-year-old woman had a retinal arterial macroaneurysm in the right eye with leakage. It had some bleeding. I did not treat her. I saw her first in February and then back in March and now she notices her vision gradually, possibly a little better. It does fluctuate though. VISUAL ACUITY: OD 20/200

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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage163 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage195 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage110 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage104 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage106 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage65 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage67 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage103 views6 Month Follow-up
91-year-old woman had a retinal arterial macroaneurysm in the right eye 6 Month Follow-up Vision is 20/200.
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage143 views6 Month Follow-up
91-year-old woman had a retinal arterial macroaneurysm in the right eye 6 Month Follow-up Vision is 20/200.
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage129 views6 Month Follow-up
91-year-old woman had a retinal arterial macroaneurysm in the right eye 6 Month Follow-up Vision is 20/200.
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Retinal Arterial Macroaneurysm - Ruptured and self-sealed after hemorrhage156 views90-year-old woman has vision loss in the right eye for 6 weeks. OD 8/200, OS 20/50. Initial Visit00000
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90-year-old woman has vision loss in the right eye for 6 weeks. She noticed a sudden change in vision. She is no longer able to read fine print. I saw her back in March of 2007. Back then the vision in the right eye was 20/30 and the left eye was 20/60 from a mild macular pucker. She was injured in the left eye from a potted plant back in 2007. VISUAL ACUITY: OD 8/200, OS 20/50. IOP: 20 OU. The right eye has a peripheral iridotomy and a posterior chamber intraocular lens in good position with open capsule. The left eye has a anterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There is posterior vitreous separation. There is a retinal arterial macroaneurysm inferotemporally in the right eye. There is edema in the fovea. There is atrophy inferotemporally. OS: Vertical C/D ratio is 0.0. There is posterior vitreous separation and 1+ epiretinal membrane. OCT SCAN: The OCT scan of the right eye shows an average central foveal thickness of 482 microns with a volume of 10.08 mm3. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a hyperfluorescence macroaneurysm just inferior to the fovea. In the late frames there is no evidence of any leakage. There is a ring of hypofluorescence around it from the hemorrhage. The left eye is angiographically normal. IMPRESSION: 1. MILD MACULAR PUCKER – LEFT EYE 2. RUPTURED AND SELF SEALED RETINAL ARTERIAL MACROANEURYSM – RIGHT EYE 3. MACULAR EDEMA – RIGHT EYE DISCUSSION: I explained to the patient all the testing suggest that the macroaneurysm has sealed itself. There is evidence from research studies that once these bleed they do tend to self seal and then often the vision improves without any need for therapy. It is possible to treat those with laser, but laser carries a risk of both popping the macroaneurysm causing more bleeding and also causing a distal branch retinal artery occlusion. I asked her to return for a check in three weeks. If at that time the macula is a little better, I will leave the eye alone, if it is the same or worse, I will probably consider laser to. 6 Month Follow-up 91-year-old woman had a retinal arterial macroaneurysm in the right eye with leakage. It had some bleeding. I did not treat her. I saw her first in February and then back in March and now she notices her vision gradually, possibly a little better. It does fluctuate though. VISUAL ACUITY: OD 20/200