Visual impairment associated with choroidal macroaneurysm in a patient with presumed anomalous short posterior ciliary artery

PURPOSE: To report the clinical findings and treatment outcomes of a patient with a choroidal macroaneurysm associated with a presumed anomalous short posterior ciliary artery. OBSERVATIONS: A 74-year-old woman with anomalous choroidal vessels had mild visual impairment. Best-corrected visual acuity (BCVA) was 20/25 in the left eye. Funduscopic examination showed a protruded orange lesion temporal to the fovea with exudative changes and retinal hemorrhage. An extensive, thick choroidal vessel network was observed in the superficial choroid. Optical coherence tomography showed a steep protruded lesion beyond the retinal pigment epithelium (RPE) and RPE elevations corresponding to an anomalous choroidal vessel network located at the RPE/Bruch's membrane complex. Optical coherence tomography angiography showed decorrelation signals corresponding to the steep protruding lesion and anomalous choroidal vessel network. Fluorescein angiography and indocyanine green angiography revealed an aneurysmal lesion and anomalous choroidal vessel network in the choroidal arterial phase. A choroidal macroaneurysm associated with a presumed anomalous short posterior ciliary artery was diagnosed. Regardless of repeated treatment with intravitreal injections of aflibercept/broluzumab and photodynamic therapy, the patient's BCVA decreased to 20/50. Finally, direct photocoagulation for choroidal macroaneurysm was performed, which resolved the exudative change, and the patient's BCVA improved to 20/25. CONCLUSIONS AND IMPORTANCE: A choroidal macroaneurysm associated with an anomalous short posterior ciliary artery could be a differential diagnosis of polypoidal choroidal vasculopathy. When visual impairment develops due to exudative changes, direct photocoagulation may be the most appropriate treatment option.