Retinal arterial macroaneurysms are distinct vascular lesions with a typically benign course. Laser treatment to these vascular lesions is controversial, and has been limited to cases of persistent macular edema. Devastating vision loss can occur, however, through vitreous or subretinal hemorrhage. We describe eight cases of retinal arterial macroaneurysms associated with subretinal or vitreous hemorrhage requiring pars plana vitrectomy. Final visual acuities ranged from 20/20 to 20/400 at most recent follow up. Until reliable indicators of rupture are identified, we suggest consideration of laser photocoagulation to clinically active, identifiable retinal arterial macroaneurysms within the macula.