Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2589_Библиотеки_им_академика_М_И_Перельмана

diabetic macular edema and should be looked for in all these eyes with fluorescein angiogra-

Microaneurysms are the hallmark of

phy and OCT [12] (Box 2.4). DR. However, macroaneurysms may also be associated with DR and are termed retinal ‘capillary macroaneurysms’ [9]. Diabetic cap­illary macroaneurysms are near the hard exu-

dates, often at the center of the circinate ring (Fig. 2.1). They are also significantly corre­lated with the severity of diabetic retinopathy [9–11]. Because of their proximity to retinal capillary microaneurysms and similar imaging features in optical coherence tomography (OCT) and indocyanine green angiography, capillary macroaneurysms in DR are thought to originate from microaneurysms. They are

2. Lp(a) if family history of premature ASCVD

likely to be overlooked in eyes with severe

5. Complete lipid prole including LDL, S cholesterol, and triglycerides

1. Rule out sarcoidosis* if RAM is

using EBUS

for anaemia, leukopenia, and lymphopenia)

*For more detailed information on diag-

nosing and detecting sarcoidosis, read­ers are advised to read the American Thoracic Society guidelines [14].

Older women with sarcoidosis, independent of hypertension, may present with RAM in the eye [15]. These patients have other eye inammation signs, including perivascular candle-wax inl­trates and multifocal choroidal granulomas. Signicantly, women with sarcoid RAMs also have a high incidence of cardiovascular disease [15]. It may be noted that RAM is seen in less than 1.5% of patients with uveitis and, if present, is highly suggestive of sarcoidosis. Most RAMs in sarcoidosis are exudative and rarely present with haemorrhage [16]. RAMs in sarcoidosis appear to be related to the formation of sarcoid granuloma in the vessel wall that leads to several changes, including capillary occlusion, duplica­tion of arterioles, irregular focal narrowing, sheathing, segmental beading, comma-shaped kinking, and ectasias that evolve into RAMs [17]. Histopathological studies have shown the pres­ence of epithelioid cell granuloma in the vessel walls and retina of patients presenting with RAM [18, 19]. For more detailed information on diagnosing and detecting sarcoidosis, readers are advised to read the American Thoracic Society guidelines [14].

Although not directly related to RAM, arterial macroaneurysms have also been described in patients with sarcoidosis’s heart, aorta, pulmo­nary artery, and brain [20–23].

ciated with intracerebral aneurysms.

The inammation of the arteriolar wall may con­tribute to the formation of RAM.Multiple RAMs were reported in a patient with toxoplasmic reti­nochoroiditis with Kyrieleis arteriolitis [37].

aneurysm’s thin, stretched wall. Posterior rup­ture may lead to intraretinal or subretinal haem­orrhage [28]. Saccular RAM may show subtle or clinically apparent pulsations during the cardiac cycle when present on the optic disc. SD-OCT may show internal hyporeectivity, which becomes hyperreective as it gets thrombosed [7, 39]. It is noted that the bursting of the optic disc macroaneurysm is often associated with branch retinal artery occlusion [40]. Near­infrared reectance imaging may reveal a cir­cumferential halo around the arteriole years before the actual development of the RAM at that site [41, 42]. Optic disc macroaneurysms undergo spontaneous thrombosis with or without complications [43].