85 year old patient referred for sudden loss of visual acuity (VA) in left eye (LE).
Patient was not treated conservatively.
On examination, the patient showed a hand movement VA (MM) in the left eye.
Ocular fundus examination revealed a rounded white-yellowish macular lesion with a probable macroaneurysm located at its upper temporal limit.
It was studied with optical coherence tomography (OCT), which showed a preretinal mass of uniform density, retained by the posterior hyaloids, corresponding to an accumulation of fibrin.
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After assessing with the patient the possibility of performing fibrinectomy for evacuating premacular, an expectant attitude was adopted.
The outcome was good, with recovery of VA with OI, which was 4/10 at 3 months.
When fibrin was cleared, a macroaneurysm was observed in the upper temporal arch.
AGF and a new OCT were performed, which showed recovery of foveal morphology with clear posterior hyaloids.
When the aneurysm was found to be permeable, it was decided to perform photocoagulation around it.
Examination of the right eye showed no abnormalities.
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Photocoagulation caused thrombosis of the aneurysm.
The VA of the LE was maintained at 4/10.
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A year later, the patient returned to our hospital, this time due to acute loss of vision in the RE.
He had VA with RE of MM and 4/10 with OI.
In FO there was preretinal hemorrhage RE.
A new expectant attitude was adopted, with recovery of VA, which improved to 4/10 in 3 months.
FFA showed arterial macroaneurysm in the lower temporal arch RE, while OCT showed detachment of the posterior hyaloid in the macula.
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Photocoagulation was performed around the aneurysm with thrombosis.
Currently, the patient has VA of 4/10 in BE, with corticonuclear cataracts that will be operated immediately.
We also performed a vascular risk study of the patient, who discovered hypertension and atrial fibrillation, which are being controlled with medical treatment.
