QuizWise 21

1. The following complication can occur, after laser photocoagulation of the retinal artery macro aneurysm 
   a.   Choroidal neovascularization 
   b.   Subretinal fibrosis 
   c.   Branch retinal artery occlusion
   d.   Increased retinal exudation and scarring
   e.   All of the above

2. The diameter of Retinal Artery Macroaneurysm (RAM) varies between
   a. 100 and 250 µm
   b. 20-40 µm
   c. 40-80 µm
   d. 80-100 µm

3. Differential diagnosis of RAM are?
   a. Polypoidal choroidal vasculopathy
   b. Background diabetic retinopathy
   c. Coat’s disease
   d. Von Hippel-Lindau disease
   e. All of the above

4. Treatment for asymptomatic retinal artery macroaneurysm is?
   a. Intravitreal bevacizumab
   b. Laser photocoagulation
   c. Vitrectomy
   d. Observation 

5. Which of the following is incorrect about RAM?
   a. Saccular or fusiform dilatations of the large arterioles of the retina
   b. RAM are mostly malignant
   c. They may show spontaneous regression
   d. Most common location is the temporal part of the retina

Answers :

1. e
   Conventional laser photo coagulation of the aneurysm is the most commonly employed treatment for symptomatic retinal arterial macroaneurysm. However, this technique has many complications, including enlargement of the laser scar, choroidal neovascularization, and subretinal fibrosis. In addition, branch retinal artery occlusion, increased retinal exudation, and scarring, with possible retinal traction, have also been reported in cases of retinal arterial macroaneurysm treated with laser photocoagulation.
   
   Cho et al. Intravitreal Bevacizumab for Symptomatic Retinal Arterial Macroaneurysm Am J Ophthalmol 2013; 155: 898–904.
   doi: 10.1016/j.ajo.2012.12.003

2. a
   Retinal arterial macroaneurysms (RAM) are acquired dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. The diameter of the dilatations varies between 100 and 250 µm.
   
   Leena Pitkanen et al. Retinal Arterial Macroaneurysms, Acta Ophthalmol. 2014 Mar.
   doi: 10.1111/aos.12210

3. e 
   One should be careful to differentiate the observed retinal aneurysmal changes from other causes of this finding including Coats’ disease, von Hippel- Lindau disease, diabetic retinopathy, and radiation retinopathy. The differential diagnosis of RAM also includes causes of macular subretinal hemorrhage including choroidal melanoma, age-related macular degeneration, polypoidal choroidal vasculopathy, and valsalva retinopathy.

Goldhagen et al. Retinal Arterial Macroaneurysms and their management, Curr Ophthalmol Rep. 2019 June
doi: 10.1007/s40135-019-00202-3

4. d
   Retinal arterial macroaneurysms (RAMs) often remain stable over time, with a natural history of eventual thrombosis with spontaneous involution. Thus, if the RAM is not involving or threatening the macula, one can consider close observation without treatment.

Goldhagen et al. Retinal Arterial Macroaneurysms and their management, Curr Ophthalmol Rep. 2019 June doi: 10.1007/s40135-019-00202-3

5.    b 

Retinal arterial macroaneurysms (RAM) are acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. The most common location for RAM is the temporal part of the retina. The natural history of the disease suggests that most of the RAMs regress spontaneously, and several patients have significant visual recovery without any treatment. RAMs have mostly benign course with spontaneous regression.

Leena Pitkanen et al. Retinal Arterial Macroaneurysms, Acta Ophthalmol. 2014 Mar.
doi: 10.1111/aos.12210