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Elhanafy A, Elsagheer S, Ookawara S, Nada S. Numerical simulation of cellular blood flow in curved micro-vessels with saccular aneurysms: Effect of curvature degree and hematocrit level. BIOMICROFLUIDICS 2024; 18:034101. [PMID: 38726374 PMCID: PMC11078268 DOI: 10.1063/5.0203220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
The dynamics of cellular blood flow in curved vessels considerably differ from those in straight vessels. It is reported that clotting development is significantly affected by vessel shape irregularities. Thus, the current study aims to investigate the effect of curvature degree and hematocrit level on cellular blood flow in a curved micro-vessel with a saccular aneurysm. Accordingly, a three-dimensional numerical simulation is performed using a validated code developed for cellular blood flow problems. The obtained results show that the cell-free layer thickness is highly dependent on the curvature degree and hematocrit level, which may have a remarkable impact on the apparent viscosity of blood as well as the dynamics of other particles such as drug particulates. The near-wall region exhibits the highest degree of cell deformation, whereas the red blood cells within the aneurysm zone remain nearly undeformed. Meanwhile, the velocity of the red blood cells decreases with the increase in curvature degree, which can affect the quality of the oxygenation process. Because of the saccular aneurysm, a considerable decrease in plasma velocity is predicted. Moreover, no secondary flows are detected in the curved vessel except in the aneurysm zone. An increase in the curvature degree is expected to reduce the blood flow rate by about 10%. Furthermore, low wall shear stress values are predicted in the straight case compared to the values at the apex of the curved vessel, which may affect the structure and function of the endothelial cells of the vessel wall and, hence, increase the aneurysm rupture possibility.
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Affiliation(s)
| | | | - Shinichi Ookawara
- Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, O-okayama, Meguro-ku, Tokyo 152-8552, Japan
| | - Sameh Nada
- Authors to whom correspondence should be addressed: and
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Meng LH, Cheng SY, Chen H, Wang YL, Zhang WF, Chen H, Zhao XY, Chen YX. Impacts of angiotensin II on retinal artery changes in apolipoprotein E deficient mice. Int J Ophthalmol 2024; 17:16-24. [PMID: 38239957 PMCID: PMC10754664 DOI: 10.18240/ijo.2024.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/20/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To investigate the impacts of angiotensin II (Ang II) on retinal artery changes in apolipoprotein E deficient (apoE-/-) mice. METHODS apoE-/- male mice were infused by minipumps with Ang II at 1000 ng/kg·min (Ang II group) or saline (control group) for 28d. They were underwent ophthalmic fundus examination on day 0, 14, and 28 of infusion. Histopathologic examination, ribonucleic acid (RNA) sequencing and local Ang II measurement of retinas were conducted. RESULTS Ophthalmic fundus examination showed Ang II infusion promoted the formation of retinal arterial aneurysm-like lesions on day 28. Optical coherence tomography revealed the ganglion cell and inner plexiform layer (GCIPL) thickness in the control group was significantly thinner than that in Ang II group (P<0.001). Hematoxylin-eosin staining demonstrated diffused swelling of GCIPL layer and its disordered structure in Ang II group. Transmission electron microscopy showed Ang II infusion caused aggravation of atherosclerotic lesions, including increased swelling, roughness, disorganization of the retinal vasculature, and vacuoles formation. RNA-sequencing and gene ontology enrichment analysis demonstrated that the structure and function of cellular membrane might be disturbed and visual function might be compromised by Ang II. The local level of Ang II was higher in Ang II infusion group but did not show significant differences compared to the control group (P=0.086). CONCLUSION Ang II infusion promotes the formation of retinal arterial aneurysm-like lesions in apoE-/- mice, causing aggravation of atherosclerotic lesions, more severe disorganization of the retinal vasculature and disturbance of the cellular membrane.
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Affiliation(s)
- Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shi-Yu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - He Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yue-Lin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
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Lin SH, Fang YH, Jia FL, Li YJ. Neurogenic dry eye associated with intravitreal injection of anti-VEGF agents. Eur J Ophthalmol 2024; 34:NP35-NP40. [PMID: 37350417 DOI: 10.1177/11206721231177475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE To report a case of neurogenic dry eye (NDE) that developed after intravitreal ranibizumab injection (IVR). CASE REPORT A 71-year-old woman had a history of cataract phacoemulsification and intraocular lens (IOL) implantation, Nd:YAG laser posterior capsulotomy and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Aneurysmal dilatation of the inferior temporal retina was found in the left fundus, which was diagnosed as retinal aneurysm, and intravitreal ranibizumab injection was administered. Dry eye was found in the left eye after the first injection. After the second injection, the patient developed severe dry eye with left eye dryness, photophobia, irritation, and blurred vision. The tear film breakup time (TBUT) value was 3 s, the Schirmer test value was 2 mm/5 min, corneal fluorescein staining (CFS) showed diffuse patellar staining of the corneal epithelium with a staining area of >50% and irregular staining at the edge of the corneal flap, and the corneal touch threshold value in the filament length was 1.5 cm in the left eye. CONCLUSIONS Patients with a history of intraocular lens implantation, Nd:YAG laser posterior capsulotomy, and femtosecond laser-assisted laser in situ keratomileusis surgery may have increased drug permeability due to an increased concentration of anti-VEGF drugs in the aqueous layer and thinning of the stromal layer of the cornea. The corneal subepithelial nerve repair mechanism was destroyed, causing neurogenic dry eye.
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Affiliation(s)
- Shu-Hua Lin
- Department of Ophthalmology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Yu-Hui Fang
- Department of Dermatology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Fa-Li Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Ying-Jun Li
- Department of Ophthalmology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China
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Lam SS, Shahlaee A, Salabati M, Klufas MA. Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy. JOURNAL OF VITREORETINAL DISEASES 2023; 7:483-489. [PMID: 37974920 PMCID: PMC10649455 DOI: 10.1177/24741264231200734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To evaluate the clinical outcomes of different types of treatment of retinal arterial macroaneurysm with vitreous hemorrhage. Methods: This retrospective cohort study comprised patients with retinal arterial macroaneurysm and vitreous hemorrhage who were examined at a single retina clinic between 2013 and 2021. Results: Treatment arms included observation (n = 33), intravitreal injections (IVIs) of antivascular endothelial growth factor agents (n = 5), and pars plana vitrectomy (PPV; n = 12). Baseline characteristics and final best-corrected visual acuity (BCVA) were similar in a combined analysis of all treatment groups (P > .05). The BCVA improved in all eyes, but the IVI and PPV arms had worse presenting BCVA. The mean number of injections was 3.6 ± 2.8. The incidence of subretinal hemorrhage was 18.2% in the observation arm, 25.0% in the PPV group (8.3% had subretinal tissue plasminogen activator), and 60.0% in the IVI group. The mean time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. There was no correlation between the number of injections and the final BCVA (r = 0.13, P = .830). The IVI and PPV arms were more frequently on anticoagulants (P = .011). There was no difference in final BCVA between those using anticoagulants (0.52 ± 0.53) vs not using anticoagulants (0.55 ± 0.65) (P = .870). Conclusions: Most patients, regardless of treatment modality, demonstrated significantly improved BCVA and similar final visual outcomes. Patients with worse presenting BCVA were more likely to undergo PPV or IVI whereas those with better presenting BCVA had excellent outcomes with observation alone. Improved BCVA was not associated with the number of IVIs or anticoagulant use.
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Affiliation(s)
- Sophia S. Lam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abtin Shahlaee
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Michael A. Klufas
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
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Xie P, Feng W, Yan R, Zhu S, Gao X. Hemorrhagic retinal arterial macroaneurysm combined with branch retinal artery occlusion treated with intravitreal conbercept injection: A case report. Medicine (Baltimore) 2023; 102:e35434. [PMID: 37904389 PMCID: PMC10615553 DOI: 10.1097/md.0000000000035434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE Branch retinal artery occlusion (BRAO) is a rare complication of retinal arterial macroaneurysm (RAM), a low-incidence ocular disease. PATIENT CONCERNS A 75-year-old woman presented with a chief complaint of blurred vision. DIAGNOSES The patient for 4 days received a diagnosis of RAM combined with BRAO. INTERVENTIONS The patient was treated with two successive intravitreal conbercept injections. OUTCOMES The patient's best-corrected visual acuity improved, and the RAM diminished. LESSONS Administration of conbercept injection might be an effective treatment for complex RAM with BRAO.
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Affiliation(s)
- Pinxue Xie
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wen Feng
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ran Yan
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Siquan Zhu
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinxiao Gao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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6
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Rao VP, Mohankumar A, Mohan S, Rajan M. Sub-hyaloid hemorrhage due to ruptured retinal artery macroaneurysm treated with YAG hyaloidotomy. Oman J Ophthalmol 2023; 16:390-391. [PMID: 37602187 PMCID: PMC10433058 DOI: 10.4103/ojo.ojo_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/26/2023] [Accepted: 03/31/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Vaishnavi Prasad Rao
- Department of Ophthalmology, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
| | - Arthi Mohankumar
- Department of Ophthalmology, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Department of Ophthalmology, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
| | - Mohan Rajan
- Department of Ophthalmology, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
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Temkar S, Stephen M, Agarwal D, Deb AK. Multilayered retinal bleed in ruptured retinal artery macroaneurysm. BMJ Case Rep 2023; 16:e254669. [PMID: 37015766 PMCID: PMC10083764 DOI: 10.1136/bcr-2023-254669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Affiliation(s)
- Shreyas Temkar
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mary Stephen
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Disha Agarwal
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Amit Kumar Deb
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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8
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Meng Y, Xu Y, Li L, He L, Yi Z, Chen C. Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review. BMC Ophthalmol 2022; 22:461. [PMID: 36451117 PMCID: PMC9710132 DOI: 10.1186/s12886-022-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature. CASE PRESENTATION A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole. CONCLUSIONS This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
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Affiliation(s)
- Yang Meng
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Yishuang Xu
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu Li
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu He
- grid.412632.00000 0004 1758 2270Physical Examination Center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Zuohuizi Yi
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Changzheng Chen
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
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Ghomashchi N, Gaboriau T, Gontier B, Rougier MB, Korobelnik JF, Delyfer MN. Évolution spontanée d’un hématome maculaire secondaire à un macroanévrisme. J Fr Ophtalmol 2022; 45:967-969. [DOI: 10.1016/j.jfo.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 10/15/2022]
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10
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Differences in clinical characteristics and treatment outcomes of submacular hemorrhage caused by age-related macular degeneration and retinal macroaneurysms: A multicenter survey from the Japan Clinical Retina Study (J-CREST) group. PLoS One 2022; 17:e0274508. [PMID: 36173964 PMCID: PMC9522260 DOI: 10.1371/journal.pone.0274508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
To evaluate the clinical characteristics, treatment trends, and visual prognosis of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) and retinal arterial macroaneurysm (RAM).
Methods
This retrospective study enrolled 187 Japanese patients with SMH at 10 institutions from 2015 to 2018. Medical records including SMH etiology, best-corrected visual acuity (BCVA), fundus photographs, optical coherence tomography images, and selected treatments were analyzed.
Results
Major causes of SMH were typical nAMD (tnAMD) (18%), polypoidal choroidal vasculopathy (PCV) (50%) and RAM (29%). Age, male/female ratio, baseline BCVA, central retinal thickness, and involved retinal layers were significantly different between etiologies (all P<0.0001). Treatment with anti-vascular endothelial growth factor drugs with and without intravitreal gas injection was chosen for half of eyes in the tnAMD and PCV groups, whereas vitrectomy was performed in 83.7% of eyes with RAM. The final BCVA improved significantly from baseline in the PCV and RAM groups (P = 0.0009, P<0.0001) and final BCVA was significantly better in the PCV group at a level similar to the other groups (P = 0.0007, P = 0.0008). BCVA improvement from baseline was significantly greater in the RAM group compared with the tnAMD (P = 0.0152) and PCV (P = 0.017) groups. Multivariate analysis revealed better final BCVA was significantly associated with younger age (P = 0.0054), better baseline BCVA (P = 0.0021), RAM subtype (P = 0.0446), and no tnAMD (P = 0.001).
Conclusions
The characteristics of, and treatment strategy for, SMH were different between the underlying diseases. Anti-vascular endothelial growth factor treatment with or without expansile gas was mainly chosen for SMH in tnAMD and PCV, whereas vitrectomy with gas was the most common treatment for RAM, and the higher rate for vitrectomy might result in the greater BCVA improvement in the RAM group than in the other groups. Final BCVA was better in PCV, RAM, and tnAMD, in that order, because patients with PCV were younger and had better baseline BCVA.
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11
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DETECTION AND CHARACTERISTICS OF UNRUPTURED RETINAL ARTERIAL MACROANEURYSMS. Retina 2022; 42:1909-1914. [DOI: 10.1097/iae.0000000000003548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Nagasato D, Iwawaki T, Tabuchi H. Need of preventive photocoagulation for retinal arterial macroaneurysm with retinal hemorrhage. Clin Case Rep 2022; 10:e05683. [PMID: 35414932 PMCID: PMC8980911 DOI: 10.1002/ccr3.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
Retinal arterial macroaneurysm shows rapid vision loss when rupture occurs; therefore, preventive photocoagulation should be considered, if necessary.
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Affiliation(s)
- Daisuke Nagasato
- Department of Ophthalmology Tsukazaki Hospital Himeji Japan.,Department of Technology and Design Thinking for Medicine Hiroshima University Graduate School Hiroshima Japan
| | | | - Hitoshi Tabuchi
- Department of Ophthalmology Tsukazaki Hospital Himeji Japan.,Department of Technology and Design Thinking for Medicine Hiroshima University Graduate School Hiroshima Japan
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13
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Mechrgui M. Multilayered Hemorrhage Secondary to Retinal Arterial Macroaneurysm Rupture: A Case Report and Review of Literature. Cureus 2022; 14:e23903. [PMID: 35530862 PMCID: PMC9076047 DOI: 10.7759/cureus.23903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Retinal arterial macroaneurysms represent an acquired vascular irregularity that is primarily observed in the elderly population. The high variability surrounding the clinical presentation of this condition makes the initial diagnosis challenging. Employing several diagnostic techniques including fundus fluorescence angiography, optical coherence tomography, and optical coherence tomography angiography ensures that any hemorrhages secondary to macroaneurysms rupture are identified promptly. This is crucial for appropriately managing the case and ensuring a good prognosis. Here, we present a case of a multilayered hemorrhage secondary to a ruptured retinal arterial macroaneurysm managed with a pars plana vitrectomy with gas tamponade and we aim to highlight the recent advancements in diagnosis and management of this condition.
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Affiliation(s)
- Monia Mechrgui
- Ophthalmology, Primary Health Care Corporation, Doha, QAT
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14
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Mohan R, Arthi M. Bilateral multiple retinal artery macroaneurysms with coexistent diabetic retinopathy. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Exercise-induced Valsalva retinopathy: A case report and literature review. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220407064k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Valsalva retinopathy is an uncommon disorder that usually presents with acute onset of unilateral, or less frequently, bilateral visual impairment varying from subtle scotoma to total vision loss. It occurs as a result of Valsalva?s maneuver. In the vast majority of cases, hemorrhage is preretinal although subretinal, intraretinal and vitreous hemorrhage can be found. Valsalva retinopathy often develops due to numerous triggering activities such as vomiting, coughing, heavy weight lifting, intense aerobic exercise, labor, and general anesthesia. Management options are either clinical observation or invasive techniques. We report a case of premacular hemorrhage due to Valsalva retinopathy induced by gym training. Case outline. A 34-year-old woman was referred to the Eye Clinic, University Clinical Center of Serbia, complaining of sudden and painless unilateral decrease in vision occurred during intense physical activity. Best corrected visual acuity was measured as counting fingers at five meters distance. Dilated fundoscopy demonstrated a large, well demarcated premacular subhyaloid hemorrhage with visible rupture of the retinal vein branch. The patient was treated conservatively. Three months after the onset of symptoms, hemorrhage absorbed and best corrected visual acuity was 20/20. Conclusion. Valsalva retinopathy, although a rare condition, should not be omitted as a differential diagnosis of retinal and vitreous hemorrhages. Standard, observational treatment is generally sufficient for complete vision recovery; however, literature suggests that an individualized approach to each patient is required.
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16
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Wang C, Cao G, Xu X, Wang J, Zhang S. Outcomes of combined treatments in patients with retinal arterial macroaneurysm. Indian J Ophthalmol 2021; 69:3564-3569. [PMID: 34826996 PMCID: PMC8837312 DOI: 10.4103/ijo.ijo_612_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: To evaluate the outcome of the combined approach between intravitreal ranibizumab (IVR) and focal laser photocoagulation (FLP) in the treatment of symptomatic retinal arterial macroaneurysm (RAM). Methods: A total of 10 patients were included in this clinical case series report. They were diagnosed with symptomatic RAM (one eye in each) and assessed by a comprehensive ophthalmologic examination, including fluorescein angiography (FA), optical coherence tomography angiography (OCT-A), and indocyanine green angiography (ICGA). All patients were treated with an IVR followed by an FLP 2 weeks later. If necessary, a second IVR was given 1 month after the first one (or 2 weeks after the first FLP), which was followed by a second FLP treatment 2 weeks later in the needed cases. All cases were followed up for 6 months after the last treatment. Results: Both the retina hemorrhage and edema were resolved by the treatment. No ocular and/or systemic side effects were evident, and no recrudescence of RAM was seen within the 6 months of follow-up. Conclusion: The combined treatment of IVRs and FLPs was successful in the management of symptomatic RAM.
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Affiliation(s)
- Chenghu Wang
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Guofan Cao
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangzhong Xu
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, Canada
| | - Shu Zhang
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
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Chen H, Zhao XY, Chen YX, Deng TT. Angiotensin II is a crucial factor in retinal aneurysm formation. Exp Eye Res 2021; 213:108810. [PMID: 34757002 DOI: 10.1016/j.exer.2021.108810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
Retinal arterial macroaneurysms are characterized by the acquired fusiform or saccular dilatations of the retinal artery. Angiotensin II (Ang II) is a major signal molecule of the renin-angiotensin system, which exerts a range of pathogenic actions that are relevant to retinal vascular abnormalities. We aimed to study the effect of Ang II on retinal vessels and explore its relationship with retinal aneurysmal disease. C57BL/6J male mice were administered Ang II at 1000 ng/kg/min for 28 days, and the mice given saline served as controls. The mice in the treatment group were treated once daily by gastric gavage of candesartan cilexetil (an antagonist of Ang II type 1 (AT1) receptor) at 100 mg/kg/day. The in vivo imaging of murine retinas was performed using fundus photography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography at 7th, 14th, and 28th days of infusion. At the end of the infusion and treatment, the morphological changes were evaluated by histopathological examination and electron microscopy; the levels of related proteins in murine retinas were examined by antibody array and Western blot analyses. We found that Ang II infusion induced aneurysm formation in mice retina, which presented as either solitary aneurysms or retinal arterial beading. The aneurysm formation was often accompanied with vessel leakage. Moreover, Ang II infusion itself may result in increased vascular permeability and ganglion cell and inner plexiform layer thickening. The blockade of AT1 receptors by systemic administration of candesartan cilexetil alleviated the Ang II-induced retinal vasculopathy. The protein level analysis further showed that Ang II upregulated IL-1β, PDGFR-β, and MMP-9 expression, and the expression of IL-1β could be inhibited by AT1 receptor antagonist. Our study provides evidence that Ang II is a crucial factor in retinal aneurysm formation and vessel leakage. It is probably the combined effect of Ang II on vessel inflammatory response, pericyte function, and extracellular matrix remodeling that predisposes the retinal arterial wall to aneurysm formation and blood-retinal barrier breakdown.
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Affiliation(s)
- He Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
| | - Ting-Ting Deng
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
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Clinical characteristics of retinal arterial macroaneurysms and prognosis of different interventions. Graefes Arch Clin Exp Ophthalmol 2021; 260:439-450. [PMID: 34453606 DOI: 10.1007/s00417-021-05364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To estimate the clinical characteristics of retinal arterial macroaneurysms (RAM) and evaluate the prognosis of different interventions. METHODS This study is a meta-analysis. The databases PubMed, EMBASE, and Ovid from inception to January 2021 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated by means of Freeman-Tukey variant of arcsine square transformation. RESULTS Sixty-nine studies involving 1332 patients were finally included. The pooling results indicated that 91% (95% CI [88 ~ 94%]) of the RAM patients were over sixty, 73% (95% CI [68 ~ 77%]) were female, and 73% (95% CI [66 ~ 79%]) have hypertension. By observation, the RAM closure rate was 64% (95% CI [39 ~ 86%]), the visual acuity (VA) improved in 55% (95% CI [40 ~ 71%]) of the patients, and the VA of 64% (95% CI [54 ~ 74%]) hemorrhagic versus 27% (95% CI [15 ~ 41%]) exudative patients improved significantly. By laser, the closure rate was 96% (95% CI [87 ~ 100%]), the VA improved in 73% (95% CI [65 ~ 80%]) of the patients, and the VA of 66% (95% CI [47 ~ 84%]) hemorrhagic versus 35% (95% CI [23 ~ 47%]) exudative patients improved significantly. By anti-VEGF, the closure rate was 98% (95% CI [93 ~ 100%]), the VA improved in 90% (95% CI [74 ~ 100%]) of the patients, and the VA of 58% (95% CI [18 ~ 94%]) hemorrhagic versus 67% (95% CI [31 ~ 96%]) exudative patients improved significantly. CONCLUSION RAM are most commonly seen in the elderly with a marked female predominance and a strong association with hypertension. Patients receiving laser or anti-VEGF treatments get higher closure rate and better visual prognosis than those with observation alone. Hemorrhagic RAM have a better visual prognosis by observation or laser treatment, while exudative RAM have a better visual prognosis by anti-VEGF treatment.
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Kim TH, Kim CZ, Lee SU, Lee SJ. Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.8.1053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms.Methods: We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups.Results: The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p < 0.001).Conclusions: Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.
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[Retinal arterial macroaneurysm and anti-Vascular Endothelial Growth Factor (aflibercept) in Eales's disease: A case report]. J Fr Ophtalmol 2020; 44:e91-e95. [PMID: 33309178 DOI: 10.1016/j.jfo.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
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Abstract
Purpose of review This is a comprehensive review of management options for retinal arterial macroaneurysms (RAMs). Although close observation is typically recommended for RAMs not involving or threatening the macula, other treatment modalities can be considered for exudative or hemorrhagic complications that are vision-threatening. Recent findings New imaging technologies like optical coherence tomography angiography (OCT-A) have been able to detect RAMs without the need of dye injection, further elucidating our understanding of blood flow within and around them. Observation alone is usually adequate treatment when lesion not threatening the fovea. Laser photocoagulation and intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors have effectively been used for management of exudative RAMs, whereas options including injection of VEGF inhibitors, tissue plasminogen activator (tPA), vitrectomy, gas, and yttrium aluminum garnet (YAG) laser have been used for hemorrhagic RAMs. Summary To date, there is no consensus regarding management of symptomatic exudative or hemorrhagic complications of RAM. Additionally, a case report is presented within this paper to illustrate the successful treatment of a hemorrhagic RAM in a symptomatic 65-year-old man using intravitreal bevacizumab.
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Lin Z, Hu Q, Wu Y, Xu J, Zhang Q. Intravitreal ranibizumab or conbercept for retinal arterial macroaneurysm: a case series. BMC Ophthalmol 2019; 19:18. [PMID: 30646868 PMCID: PMC6334469 DOI: 10.1186/s12886-019-1035-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no consensus for the standard treatment of retinal arterial macroaneurysm (RAM). Intravitreal anti-vascular endothelium growth factor (anti-VEGF) is an alternative treatment option for RAM. The purpose of this study is to describe the clinical efficacy of intravitreal ranibizumab or intravitreal conbercept for retinal arterial macroaneurysm. CASE PRESENTATION Three cases that presented with symptomatic RAM were treated with intravitreal anti-VEGF agents. Two eyes received two intravitreal ranibizumab injections with a time interval of one month and completed a one-year follow-up, while one eye only received one intravitreal conbercept injection and was followed up for six months. Both the retinal thickness and the visual acuity were significantly improved at the final clinic visit. The macular hemorrhage and edema were resolved. There were no ocular or systemic side effects. CONCLUSIONS Intravitreal ranibizumab or conbercept might be used as a therapeutic option for symptomatic retinal arterial macroaneurysm patients. Anti-VEGF therapy should be further investigated in a larger series with longer follow-up for this disease profile.
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Affiliation(s)
- Zhongjing Lin
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Qiwei Hu
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yanlin Wu
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jianmin Xu
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Qiong Zhang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
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Garcia-Saenz MC, Ferreiro Lopez J, Bañuelos Bañuelos J, Arias-Puente A. Retinal macroaneurysm rupture. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:e68. [PMID: 29398226 DOI: 10.1016/j.oftal.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- M C Garcia-Saenz
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - J Ferreiro Lopez
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - J Bañuelos Bañuelos
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - A Arias-Puente
- Servicio de Oftalmología, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Oztas Z, Nalcaci S, Akkin C. Intravitreal aflibercept for ruptured retinal arterial macroaneurysm. Int J Ophthalmol 2017; 10:491-493. [PMID: 28393046 DOI: 10.18240/ijo.2017.03.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/15/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zafer Oztas
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova 35040, İzmir, Turkey
| | - Serhad Nalcaci
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova 35040, İzmir, Turkey
| | - Cezmi Akkin
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova 35040, İzmir, Turkey
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Intravitreal ranibizumab for retinal arterial macroaneurysm: long-term results of a prospective study. Eur J Ophthalmol 2017; 27:215-219. [PMID: 27646333 DOI: 10.5301/ejo.5000863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the potential efficacy and safety of primary intravitreal ranibizumab in patients with symptomatic retinal arterial macroaneurysm (RAM). METHODS This prospective study comprised 5 eyes with RAM treated with intravitreal ranibizumab. At baseline, all patients underwent best-corrected visual acuity (BCVA) measurement, ophthalmic examination including slit-lamp biomicroscopy, and central foveal thickness (CFT) measurement using optical coherence tomography. Fluorescein angiography was also performed to confirm diagnosis. Patients were examined at 1 month after injection and monthly thereafter. Main outcome measures included changes in BCVA and CFT. Safety was assessed by ophthalmic examination and report of systemic adverse effects. RESULTS There was a statistically significant difference in BCVA (p<0.001) and CFT (p<0.001) before and after the ranibizumab injection at the end of the follow-up of 13.4 ± 3.2 months. One injection appeared to be sufficient for the resolution of macular edema and absorption of hemorrhages. No observable ocular or systemic side effects were found. One patient developed foveal atrophy. CONCLUSIONS Intravitreal ranibizumab seems to be effective and safe for the treatment of symptomatic RAM.
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Nalcaci S, Oztas Z, Eraslan C, Akkin C. Are Multiple Retinal Arterial Macroaneurysms Considered a Sign of Cerebral Aneurysms? Ophthalmic Surg Lasers Imaging Retina 2017; 48:79-82. [PMID: 28060399 DOI: 10.3928/23258160-20161219-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
The aim of this study is to report the coexistence of retinal arterial macroaneurysms (RAMs) and cerebral aneurysms (CAs) in a 58-year-old woman with hypertension. She was noted as having a 1-week history of vision loss in her left eye, along with a 2-month history of a nonspecific headache. Visual acuity was 20/32 in her left eye and 20/20 in her right eye. A fundus examination revealed multiple areas of retinal hemorrhages that were surrounded by circinate exudation in her left eye, as well as the generalized attenuation of the retinal arteries in both of her eyes. Angiographically, hyperfluorescent round leakage points confirmed the presence of five saccular RAMs. Surprisingly, computed tomography angiography completed based on the recommendation of neurology department identified three saccular CAs. Aging, hypertension, and female preponderance are the common risk factors for both RAMs and CAs. Accordingly, RAMs and CAs may exist simultaneously in hypertensive patients. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:79-82.].
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