Hypertensive retinopathy treatment: Which intervention is recommended if a macroaneurysm is leaking?

• A. Refer to PCP for BP control
• B. Refer to ER for malignant HTN
• C. Focal laser treatment
• D. Observation only

Answer: (C)

When a retinal arterial macroaneurysm leaks, the goal is to stop the leakage at the source and reduce macular edema to protect vision. Focal laser photocoagulation directed at the macroaneurysm accomplishes this by sealing the vessel wall, halting further leakage, and allowing the edema to resolve, often improving or stabilizing vision. While controlling blood pressure systemically is important, it does not directly address the leaking aneurysm. Referring to the emergency room for malignant hypertension isn’t indicated unless there are signs of a hypertensive crisis, and simply observing a leaking macroaneurysm can allow ongoing damage. Therefore, focal laser treatment is the most appropriate intervention.