85 year old patient referred for sudden loss of visual acuity (VA) in the left eye (LA). He was not taking any medication and had no ophthalmological or general pathological history.
On examination, he showed hand movement VA (WM) in the left eye. Fundus examination (FO) revealed a rounded, yellowish-white macular lesion with a probable retinal macroaneurysm at the upper temporal limit. It was studied with optical coherence tomography (OCT), which showed a preretinal mass of uniform density, retained by the posterior hyaloid, which corresponded to an accumulation of fibrin.
After discussing with the patient the possibility of performing a vitrectomy to evacuate the premacular fibrin, a wait-and-see approach was adopted. The evolution was good, with recovery of VA with the OI, which was 4/10 at 3 months.
When the fibrin cleared, a macroaneurysm was observed in the superior temporal arch. FFA and a new OCT were performed, which showed recovery of foveal morphology, with posterior hyaloid detached. As the aneurysm was found to be patent, it was decided to perform photocoagulation around the aneurysm. Examination of the OD showed no abnormalities.
Photocoagulation caused thrombosis of the aneurysm. The VA of the LAA was maintained at 4/10.
One year later, the patient returned to our hospital, this time for acute loss of vision in the RA. He had VA with MM OD and 4/10 with OI. In FO there was a preretinal haemorrhage in OD.
A wait-and-see approach was again adopted, with recovery of VA, which improved to 4/10 in 3 months. FFA was performed, which revealed an arterial macroaneurysm in the inferior temporal arcade OD, while OCT showed detachment of the posterior hyaloid in the macula.
Photocoagulation was performed around the aneurysm, with thrombosis of the aneurysm.
The patient currently has a VA of 4/10 in AO, with dense corticonuclear cataracts that will be operated on soon.
In addition, a vascular risk study was carried out on the patient, which revealed hypertension and atrial fibrillation, which are being controlled with medical treatment.
