Serial bevacizumab injections and laser photocoagulation for macular edema associated with a retinal artery macroaneurysm

Abstract

An 84-year-old female with a history of hypertension and dyslipidemia was referred for a retinal artery macroaneurysm with exudation that had extended into the macula. She underwent a total of six injections of bevacizumab, with some improvement in visual acuity and retinal thickness. Due to persistent macular edema, focal laser photocoagulation was performed around the macroaneurysm. The vision remained at 20/30 during 20 months of follow up. Although anti-vascular endothelial growth factor therapy may improve vision and decrease retinal thickness in retinal artery macroaneurysm, recalcitrant cases may be treated with laser photocoagulation to seal the leaking vessel.

Retinal arterial macroaneurysm associated with macular pucker

“…7,8 In addition, vascular occlusion, arteriovenous shunts, enlargement of laser scar, choroidal neovascularization and subretinal fibrosis could have been further complications, related to conventional laser treatment. 7–10…”

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.…”

“…[20] In one report, once 6 injections were performed, indirect thermal laser was applied with subsequent complete resolution of fluid. [46]…”