Maurice F. Rabb » Multiple Retinal Arterial Macroaneurysms

A 50 year old white male, ocularly asymptomatic, sent for an eye examination because of systemic sarcoidosis diagnosed by transbronchial biopsy following abnormal pulmonary function studies.

Past Medical History:
Systemic sypertension for four years with intermittent therapy.

Ocular Examination:
O.D. 20/25 (+2.50) +2.25 Jl O.D. 14
O.S. 20/25 (+2.50) +2.25 Jl O.S. 14

Anterior segment O.U.: normal

Peripheral retina and vitreous O.U.: normal

Disc O.U.: sharp margin; C/D ratio of 0.3

Macula O.U.: few scattered drusen

Vessels O.D.: arterial irregularity with some beading; arterial loop along inferior temporal artery; moderate A-V crossing changes

Vessels O.S.: arterial irregularity; arterial loop with segmental dilation of superior artery on disc at 11:00 o'clock; second loop on superior macular artery; arterial macroaneurysms along superior temporal artery 11/2 DD from disc with some surrounding retinal hemorrhage; another macroaneurysm on disc edge at 4:00 o'clock on a cilioretinal vessel. Also present: cilioretinal artery 11/2 DD inferior to disc at 6:00 o'clock.

Fluorescein Angiography:
Fluorescein angiography of the posterior pole of the left eye shows that at the onset of the retinal arterial phase there is filling of the arterial loop and both macroaneurysms. The macroaneurysm at the edge of the disc at 4:00 o'clock fills from a cilioretinal vessel. In the arteriovenous phase there is a halo of hypofluorescence around both the loop and the superior macroaneurysms, along with some areas of dilated capillaries. There is also blockage of some of the vessels in the region of the superior macroaneurysms secondary to the hemorrhage. In the late states there is leakage from the loop on the disc as well as the superior macroaneurysms. The inferior cilioretinal artery is not seen in the early phases; therefore, direction of flow cannot be ascertained. There are some pigmentary changes in the macular region which behave like window defects in the late stages.

The right eye, in the mid and late stages, shows arterial irregularity and the arterial loop, without leakage. There are some window defects superior nasal to the fovea.

In our review of 43 cases of arterial macroaneurysms, we have not previously noted on on a cilioretinal artery.