Congenital Retinal Macrovessel May Indicate Systemic Comorbidities

A congenital retinal macrovessel (CRM) may result in alterations to foveal architecture and be associated with systemic comorbidities, according to a poster presented at the 2023 Southeastern Educational Congress of Optometry (SECO) meeting in Atlanta from March 1 to 5.

Julie Rodman, OD, and Mariana Ferraz, OD, of Nova Southeastern University’s college of optometry, detailed clinical findings, complications, and management strategies associated with CRM and presented data from 2 case studies.

Although rare, with a prevalence of 1 in 200,000 individuals, optometrists may encounter these grossly enlarged vessels, which extend across the central macula, during routine eye exams. Research suggests that this idiopathic finding forms at 15 to 16 weeks gestation and may be associated with venous anomalies of the brain.

Despite its frequently asymptomatic nature, CRM can lead to ocular complications, including angioscotoma, foveolar cysts, macular hemorrhages or exudates, pigmentary changes, serous macular detachment, and foveal displacement — all of which may diminish visual acuity.

Fluorescein angiography may reveal tributaries over the macula, but not the foveal avascular zone. Optical coherence tomography (OCT) assessment indicates CRM penetration that is not deeper than the outer nuclear layer — a finding showing that CRM lacks an intervening retinal capillary plexus.

Because of potential cerebral associations with CRM, the poster presenters suggest  brain magnetic resonance imaging with contrast for these patients.