Retinal artery aneurysmal abnormalities

Retinal artery microaneurysm (RAM), perifoveal vascular anomalous complex (PVAC), and retinal capillary microaneurysm (RCM) are vascular dilatations that share common findings, although they differ in location and the type of vessel involved in the abnormal dilatation. They are typically solitary, unilateral, idiopathic, and affect elderly subjects. They can be isolated or occur in concomitance with other retinal diseases. These alterations are asymptomatic until vascular leakage induces macular edema but may also spontaneously regress. RAM is often associated with retinal or vitreous hemorrhage while PVAC and RCM are mostly accompanied by exudation. Multimodal imaging is essential for the study of these lesions and for the differential diagnosis. They appear as hyporeflective areas surrounded by a hyperreflective wall situated in the inner retinal layers, corresponding to a hyperfluorescent lesion on fluorescein and indocyanine green angiography (ICGA). The gold standard therapy has not yet been established but aneurysmal dilatations seem to respond to laser treatment. Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) are ineffective in most cases of PVAC and RCM while such treatment is quite efficient in RAM. Functional and visual outcomes depend on the duration of foveal exudation or subretinal hemorrhage and the subsequent extent of photoreceptor damage.