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  • = Localised dilation of a retinal arteriole
  • Often occurs in older women, associated with arterial hypertension; bilateral in 10%

Findings / Work-up

  • Fundus examination: saccular/fusiform arterial dilation, often near an arteriovenous crossing, frequently temporal/superotemporal
  • Retinal bleeding in 50%: intra-, sub-, or preretinal
  • Exudations with chronic leakage
  • Complications: Epiretinal membrane, choroidal neovascularization
  • Fluorescein angiography: causes?
    • Is there an aneurysm? Leakage? Consider differential diagnosis (parapapillary) choroidal neovascularisation (CNV), other etiology?
  • OCT: helpful for quantification/monitoring of exudation


  • Investigation of vascular risk factors (especially arterial hypertension + dyslipidemia) + appropriate therapy
  • No guidelines for the management of macroaneurysms
  • Observation:
    • Most macroaneurysms thrombose and spontaneously disappear over time
    • Justified with good vision and no threat to the macula
  • Anti-VEGF:
    • for macular edema
  • Focal laser coagulation:
    • Evaluate laser coagulation if evidence of an aneurysm with leakage/edema in the area of the fovea or with a threat to the fovea
    • Laser indication not given if the aneurysm is already infarcted/thrombosed
    • Various techniques possible
      • Direct laser photocoagulation: create a light burn directly to the macroaneurysm with minimal power (100-300mW), large spot size (200-500µm), longer duration (200-500ms)
      • Indirect laser photocoagulation: confluent burns around the aneurysm, not directly to the macroaneurysm, 400mW, 200µm, shorter duration (100-200ms)
  • YAG laser hyaloidotomy:
    • Can be considered for persistent preretinal bleeding (controversial)
    • The goal is for blood to drain into the vitreous space and be absorbed more quickly there
  • Surgery:
    • intravitreal gas injection with/without rtPA for macular bleeding
    • vitrectomy for persistent vitreous hemorrhage


  • EyeWiki Macroaneurysm
  • AAO Diagnosis and Management of Retinal Arterial Macroaneurysms
  • Singh D, Tripathy K. Retinal Macroaneurysm. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition(2015)