Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab

Abstract

Purpose: We report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab. Methods: We report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented. Results: His best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment. Conclusions: Intravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.

Intravitreal Anti-Vascular Endothelial Growth Factor for Macular Edema due to Complex Retinal Arterial Macroaneurysms

“…However, there has been a consensus for treatment for complications such as macular edema or macular or vitreous hemorrhage [ 4 , 5 ]. For this, intravitreal injections can be considered, and there has been published data about the use of bevacizumab and ranibizumab [ 7 , 8 , 10 ]. Data concerning the use of aflibercept do not exist so far.…”

“…Successful treatment of these lesions with intravitreal anti-VEGF therapy has already been shown in several case reports and studies [6, 7, 8, 9]. However, the pathogenesis has not been fully clarified.…”

Intravitreal Ranibizumab for Retinal Arterial Macroaneurysm: Long-Term Results of a Prospective Study

“…Intravitreal anti-VEGF injections are more recent therapeutic alternatives, being shown to reduce vascular permeability, normalize central retinal thickness, and lead to visual stabilization or slight improvement (1, 4–5–6–7–8–9–10–11–12–13–14–15). In our case series, intravitreal ranibizumab was found to improve visual acuity from 0.62 to 0.37 logMAR and provide anatomical recovery by decreasing macular edema from 631.4 to 256.6 μm at the long-term follow-up of 13.4 ± 3.2 months, as well as promoting the absorption of hemorrhages.…”

“…Nowadays, in the era of anti-vascular endothelial growth factor (VEGF) treatment, there have been several reports suggesting the use of intravitreal bevacizumab or ranibizumab for the treatment of RAM, showing encouraging results, but having limited follow-up time (4–5–6–7–8–9–10–11–12–13–14–15). In light of the above, the purpose of this study was to evaluate the anatomical and functional results after intravitreal ranibizumab injections for the treatment of symptomatic RAM in a long-term follow-up.…”

Retinal Arterial Macroaneurysms: Updating Your Memory on RAM Management

“…[17] Although Chatziralli et al found that only one injection was needed for resolution of macular edema, [44] other authors reported requiring more injections until fluid resolved completely. [43,45,46] The use of anti-VEGF agents does not preclude the use of laser, which Chen et al suggest may better reduce macular edema. [20] In one report, once 6 injections were performed, indirect thermal laser was applied with subsequent complete resolution of fluid.…”