Double Trouble⁠!!⁠
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This 60yo lady had sequential paracentral and central scotomas following trivial trauma and valsalva events. ⁠
She initially had large multilayered bleeds in both eyes (images 1 &2) and underwent vitrectomy in the left eye for central sub-ILM bleed overlying her macula seen on OCT imaging (images 3&4), fortunately there was no subfoveal blood in either eye. ⁠
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Images 6 & 7 show resolution of the subILM bleed in the RE with observation over 4 months. ⁠
⁠She has managed to retain 6/6 vision in both eyes. ⁠
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These pseudocolour Optos photos show bilateral ruptured Retinal Artery Macroaneurysms (RAMA), most often associated with longstanding systemic hypertension in older females. They are described as a localised dilatation of retinal arteriole within 3 orders of arterial tree at birfurcations, with 90% being unilateral. ⁠

⁠Image 8 is from another patient and demonstrates the typical appearance of a RAMA on angiography.⁠
Treatments usually include observation or thermal laser if there is sight threatening exudation. Surgery is only usually required for ruptured RAMAs that obscure vision through vitreous haemorrhage or central involvement. ⁠
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It’s important to liaise with the patient’s Primary Care Physician to ensure that cardiovascular risk factors are well controlled. ⁠

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