Congenital anomalous retinal artery is a unilateral vascular anomaly with an excellent visual prognosis. Aberrant macular vessels are rare.1 Anomalous macular veins, although rare, are more common than anomalous macular arteries.2
A 71-year-old man was referred to the retina service for "bleeding behind the right eye." His medical history was significant for ischemic heart disease, hypertension, and emphysema. He was using anitglaucoma medication. On examination, his best-corrected visual acuity was counting fingers at 4 m OD and 20/50 OS. Results of anterior segment evaluation were unremarkable, with normal intraocular pressure.
Ophthalmoscopy of the right eye revealed an aberrant artery that extended from the inferior temporal arcade (Figure 1), crossed the macula, and was associated with a macroaneurysm, subretinal hemorrhage, and macular edema. The posterior segment of the left eye was normal (Figure 1, insert).
Red-free fundus photograph of the right eye shows the anomalous artery originating from the inferior temporal vessel and crossing the midline toward the fovea. Note the associated macular edema and hard exudates. Insert, red-free photograph of the left eye shows a normal fundus.
Fluorescein angiography confirmed the presence of the anomalous inferior temporal branch along with a leaking macroaneurysm in the macular area (Figure 2). There was evidence of early filling and late emptying of the aneurysm (Figure 2). Because of macular involvement, the patient underwent focal photocoagulation (532-nm green laser). Six weeks following treatment, his visual acuity improved to 20/100 OD.
Fundus fluorescein angiography of the right eye. The image at 15 seconds (arteriovenous phase) reveals early filling of the aneurysm. The picture at 35 seconds shows a well-delineated aneurysm. At 5 minutes, there is increased intensity of the dye in the aneurysm suggestive of delayed emptying with a surrounding mild leak.
A congenital retinal macrovessel is a rare, unilateral retinal vascular anomaly. This large anomalous vessel may cross the foveal region and horizontal raphe. In our patient, fluorescein angiography demonstrated early filling with delayed emptying of the aberrant vessel associated with a dilated capillary bed surrounding the macrovessel.3 Congenital retinal macrovessels are typically associated with normal visual acuity.3
Macroaneurysms are usually solitary, acquired dilatations of retinal arteries associated with hypertension and atherosclerosis. Venous aneurysms have also been reported.4 Elevated intraocular pressure may predispose to leakage.
While congenital anomalous macrovessel is frequently a stable clinical entity, our patient had a congenital retinal macrovessel that crossed the medial raphe and was associated with a leaking juxtafoveal macroaneurysm. We postulate the possibility of the patient's hypertension and vascular disease causing the development of a macroaneurysm in association with an anomalous artery. A leaking macroaneurysm of an anomalous artery crossing the fovea is an unusual occurrence and, to the best of our knowledge, has not been previously reported.
Corresponding author and reprints: K. V. Chalam, MD, Health Science Center/Jacksonville, Department of Ophthalmology, 580 W 8th St, Jacksonville, FL 32209.
Chalam KV, Gupta SK, Vinjamaram S, Shah VA. Congenital Anomalous Retinal Artery Associated With a Leaking Macroaneurysm. Arch Ophthalmol. 2003;121(3):409-410. doi:10.1001/archopht.121.3.409