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Ophthalmic Images
April 11, 2019

Swept-Source Optical Coherence Tomography Angiography of Retinal Arterial Macroaneurysm With Overlying Hemorrhage

Author Affiliations
  • 1Vitreous Retina Macula Consultants of New York, New York
  • 2Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
  • 3Department of Ophthalmology, New York University, New York, New York
  • 4Manhattan Eye, Ear, and Throat Hospital, New York, New York
JAMA Ophthalmol. 2019;137(4):e190247. doi:10.1001/jamaophthalmol.2019.0247

A patient in their 90s with hypertension and diabetes type 2 noted the sudden onset of decreased visual acuity of 20/70 OS due to a subinternal limiting membrane macular hemorrhage. Blood obscured the view posteriorly, evidenced by blocked fluorescence exceeding 5 minutes on fluorescein angiography (Figure, A). Swept-source optical coherence tomography angiography (SS-OCTA) demonstrated a retinal arterial macroaneurysm (Figure, B). The SS-OCTA uses scatter from high-speed acquisition (100 000 A-scans/s) with a long center wavelength (1040-1060 nm),1 allowing for deep penetration of light through retinal tissue and, in this case, hemorrhage. Although indocyanine green angiography can be useful for imaging retinal lesions obscured by hemorrhage, in this eye, the aneurysm was easily seen with SS-OCTA. This case demonstrates how SS-OCTA, without infusion of fluorescein or indocyanine green, can detect a retinal arterial macroaneurysm obscured by hemorrhage on fluorescein angiography.

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