Late fluorescein leakage from within the areas of hemorrhage is characteristic of the aneurysms and may assist in the diagnosis when the vasculature is not visible on direct examination. Histologic studies of the macroaneurysm show a break in the arterial wall, surrounded by a laminated layer of fibrin-platelet clot and blood. Lipid-laden macrophages, hemosiderin, and fibroglial reaction also are observed. The treatment of retinal macroaneurysms by direct laser photocoagulation is controversial. The natural history of the disease suggests that many patients have significant visual recovery without treatment.
Treatment generally is recommended for persistent or progressive exudation in the macula.
Direct treatment of the aneurysm is performed. In the setting of dense subhyaloid hemorrhage, YAG laser hyaloidotomy has been performed to release the sequestered blood into the vitreous cavity. Release of blood that is sequestered over the macula may reduce the risk of macular scarring and epiretinal fibrosis. This procedure is controversial because of the risk of macular injury and vitreous hemorrhage. Surgical evacuation In rare settings where vitreous hemorrhage is present and the etiology of bleeding is unclear, vitrectomy surgery may be indicated.