A 45 years old patient consulted for a sudden decrease in visual acuity in the right eye. Ophthalmological examination gave visual acuity limited to luminous perceptions with a calm anterior segment, a transparent lens and at the fundus examination a dense, massive, two-level intra-retinal and retro hyaloidal pigeon nest hemorrhage with a fusiform whitish lesion on the path of the upper temporal artery. The suspected diagnosis was a complicated ruptured retinal macroaneurysm with massive retinal and retro hyaloidal hemorrhage. Fluorescein angiography confirmed the diagnosis. Our course of action was an emergency programmed evacuation vitrectomy with gas tamponade. The evolution was marked by a clear improvement in visual acuity. The rupture of retinal macroaneurysm is a frequent and serious accident. The complications of this rupture can threat the vision. Care is still being discussed. Randomized studies on large series are necessary to decide on the best therapy.
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