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Huang Y, Zheng WW, Li YZ, Sun ZH, Lin B. Retinal laser photocoagulation and intravitreal injection of anti-VEGF for hemorrhagic retinal arterial microaneurysm. Int J Ophthalmol 2023; 16:2041-2048. [PMID: 38111952 PMCID: PMC10700086 DOI: 10.18240/ijo.2023.12.17] [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: 01/15/2023] [Accepted: 09/14/2023] [Indexed: 12/20/2023] Open
Abstract
AIM To evaluate the efficacy of retinal laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for hemorrhagic retinal arterial macroaneurysm (RAM). METHODS This was a retrospective clinical study. Patients with hemorrhagic RAM were divided into 4 groups defined by different treatments: a retinal laser photocoagulation therapy monotherapy group, an anti-VEGF intravitreal injection monotherapy group, a laser and anti-VEGF combination therapy group, and an observation group. Visual acuity (VA), central macular thickness (CMT), and retinal hemorrhage area (RHA) were collected. RESULTS Forty-seven eyes of 47 patients were enrolled. VA improved and had a significant difference between baseline and final in each treatment group (logMAR; laser group: 1.90±0.53 vs 1.05±0.63, P<0.001; anti-VEGF group: 1.75±0.63 vs 1.12±0.54, P=0.009; combination group: 1.76±0.38 vs 1.01±0.52, P<0.001); however, VA decreased and had no significant difference in observation group (1.63±0.51 vs 1.76±0.61, P=0.660). CMT decreased and had a significant difference between baseline and final in each group (laser group: 815.16±310.83 vs 252.05±83.90 µm, P<0.001; anti-VEGF group: 725.00±290.79 vs 203.56±69.89 µm, P=0.001; combination group: 595.50±186.51 vs 253.13±55.06 µm, P=0.001; observation group: 758.88±195.65 vs 267.00±120.90 µm, P=0.001). RHA were 28.99±28.15, 25.94±11.58, 19.64±8.97, and 27.45±13.76 mm2 in laser group, anti-VEGF group, combination group and observation group, respectively. RHA was statistically correlated with final VA (P=0.032) in the observation group. CONCLUSION Both laser and anti-VEGF treatments are effective for hemorrhagic RAM. Combination therapy reduces the number of injections of anti-VEGF. RHA is a visual prognosis predictor in the natural history of hemorrhagic RAM.
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Affiliation(s)
- Ying Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wei-Wei Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ying-Zi Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zu-Hua Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Bing Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Muacevic A, Adler JR, Che Hamzah J. Objective Assessment of Retinal Artery Macroaneurysm With Optical Coherence Tomography Angiography. Cureus 2022; 14:e32328. [PMID: 36628049 PMCID: PMC9825258 DOI: 10.7759/cureus.32328] [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] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Retinal artery macroaneurysm (RAM) is an acquired retinal arteriole dilatation with vision-threatening complications. Diagnosis of this condition can be made clinically, supported by multi-modal imaging modalities, commonly optical coherence tomography (OCT) and dye-based angiography studies which show the lesion itself and the complications to the adjacent retina. We report a case of an 83-year-old patient with renal impairment who had the diagnosis and monitoring of RAM done using optical coherence tomography angiography (OCT-A) as an alternative to conventional fluorescein angiography. This case highlighted the use of OCT-A using Cirrus 5000 with AngioPlex (Zeiss, Jena, Germany) as a useful diagnostic and monitoring tool for RAM with its features that enables objective quantification of the disease activity via vessel and perfusion density pre- and post-laser treatment.
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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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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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Kim JH, Kim JW, Kim CG, Lew YJ, Cho HJ. Influence of bevacizumab therapy and intraretinal hemorrhage in long-term outcomes of hemorrhagic retinal arterial macroaneurysm. Sci Rep 2021; 11:14246. [PMID: 34244580 PMCID: PMC8270924 DOI: 10.1038/s41598-021-93811-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the long-term visual outcomes of hemorrhagic retinal arterial macroaneurysm (RAM), particularly focusing on the influence of bevacizumab therapy and intraretinal hemorrhage (IRH) on the outcomes. This retrospective study included 49 patients diagnosed with hemorrhagic RAM. Patients were divided into the bevacizumab group and observation group depending on the whether they were administered bevacizumab treatment and the IRH group and the non-IRH group based on the presence of IRH at the fovea. Best-corrected visual acuity (BCVA) at diagnosis was compared with that at the final visit. Further, the BCVA at the final visit was compared between the study groups. Multivariate analysis was also performed to identify factors associated with poor BCVA at the final visit. The mean follow-up period was 24.8 ± 15.3 months. The mean logarithm of minimal angle of resolution BCVA was significantly improved from 1.37 ± 0.70 at diagnosis to 0.72 ± 0.62 at the final visit (P < 0.001). There was no significant difference in the BCVA at the final visit between the bevacizumab group and observation group (P = 0.576). However, the BCVA at the final visit was significantly worse in the IRH group than in the non-IRH group (P = 0.002). In multivariate analysis, the presence of IRH was significantly associated with poor BCVA (P = 0.007). Significant long-term visual improvement was noted in hemorrhagic RAM. However, the presence of IRH at the fovea was associated with poor visual prognosis. Bevacizumab therapy did not significantly influence the outcomes.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Young Ju Lew
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Hanazaki H, Yokota H, Aso H, Yamagami S, Nagaoka T. Evaluation of ocular blood flow over time in a treated retinal arterial macroaneurysm using laser speckle flowgraphy. Am J Ophthalmol Case Rep 2021; 21:101022. [PMID: 33598588 PMCID: PMC7868799 DOI: 10.1016/j.ajoc.2021.101022] [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] [Received: 09/18/2020] [Revised: 11/15/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To report the changes over time in ocular blood flow quantified by laser speckle flowgraphy (LSFG) in a treated large retinal arterial macroaneurysm (RAM). Observations A 72-year old female presented with sudden decreased vision in the left eye. Fundus examination revealed a RAM and vitreous hemorrhage (VH), which worsened over one month. A vitrectomy was performed to remove the VH, with 20% sulfur hexafluoride injected into the vitreous cavity. The VH recurred two weeks later and the RAM was found to have enlarged from one-quarter disc diameter (DD) to three DDs during a second vitrectomy. The RAM subsequently shrunk spontaneously to one DD without recurrent VH during the following 2 weeks. Beginning 4 weeks after the second vitrectomy we performed serial LSFG examinations of the RAM and found that the mean blur rate (MBR) of the RAM and retinal flow volume (RFV) in both the feeding arteriole and draining venule decreased as the RAM continued to involute. Conclusions and importance MBR and arteriolar and venular RFV measured by LSFG decreased with RAM involution. Longitudinal followup of blood flow by LSFG may be useful for noninvasive evaluation of the stability of RAMs.
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Affiliation(s)
- Hirotsugu Hanazaki
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Harumasa Yokota
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Aso
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Taiji Nagaoka
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
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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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Optical coherence tomogrpaphy in differential diagnosis of retinal arteriolar macroaneurysms. OPHTHALMOLOGY JOURNAL 2019. [DOI: 10.17816/ov2019233-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim. To study the prevalence and topographical distribution of retinal exudation in eyes with retinal arteriolar macroaneurysms (RAM) and in those with macular branch retinal vein occlusions (mBRVO).
Methods. The prevalence of optical coherence tomography (OCT) signs (different types of retinal hemorrhages and accumulation of fluid as well as hard and soft exudates) was evaluated in 28 eyes with RAM (22 males, 6 females, mean age 66.0 ± 9.9 years) versus 17 eyes with mBRVO (9 males, 7 females, mean age 56.9 ± 10.5 years). Topographical distribution of retinal exudation on OCT retinal maps was evaluated in 7 RAM eyes (6 males, 1 female, mean age 66.0 ± 11.7 years) and 8 mBRVO eyes (5 males, 3 females, mean age 60.1 ± 19.2 years). The measures were 1) position of the point of the maximum retinal thickness in relation to the macular center and RAM, 2) difference between maximum retinal thickness in the macular center and that at the site of RAM localization (surrogate control point in mBRVO eyes).
Results. Soft exudates and intraretinal fluid accumulation were mostly associated with mBRVO (p = 0.007 and p < 0.001, respectively), while hard exudates were found almost exclusively in RAM eyes (p < 0.001). Central retinal thickness in RAM eyes was lower than that of mBRVO eyes, 453.1 ± 148.6 μm and 797.5 ± 179.6 μm, respectively (p = 0.001). The point of maximum retinal thickness was found at the site of RAM localization in 8 out of 9 RAM cases (88.9%), and within the central subfield in 8 out of 8 mBRVO cases (100%). The difference between maximum retinal thickness in the macular center and at the site of RAM localization (surrogate control point in mBRVO eyes) was –77.9 ± 174.1 μm and 148.3 ± 100.4 μm for RAM and mBRVO eyes, respectively (p < 0.001).
Conclusions. Evaluation of exudative signs and their topographic distribution based on OCT data may be used for differential diagnosis and laser treatment planning in RAM.
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Kim JS, Chae JB, Kim JY, Hyung SM, Kim DY. Bevacizumab Monotherapy for Macular Hemorrhage Secondary to a Retinal Arterial Macroaneurysm. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Soo Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jin Young Kim
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sung Min Hyung
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Maltsev DS, Kulikov AN, Uplanchiwar B, Lima LH, Chhablani J. Direct navigated laser photocoagulation as primary treatment for retinal arterial macroaneurysms. Int J Retina Vitreous 2018; 4:28. [PMID: 30151240 PMCID: PMC6104015 DOI: 10.1186/s40942-018-0133-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of conventional and navigated laser photocoagulation as the primary treatment option for retinal arteriolar macroaneurysm (RAM). METHODS Eleven (9 male and 2 females, mean age 65.1 ± 12.1 years) and 17 (13 male and 4 females, mean age 66.2 ± 8.9 years) patients were included in conventional laser photocoagulation (CLP) and navigated laser photocoagulation (NLP) groups, respectively. The primary outcome measures were LogMAR best-corrected visual acuity (BCVA) and central retinal thickness at the end of the follow-up. The secondary outcome measure was total laser energy applied during the procedure. RESULTS At the end of the mean follow-up of 11.4 ± 4.0 months, baseline LogMAR BCVA increased significantly from 0.65 ± 0.14 to 0.26 ± 0.12 (p < 0.001) in CLP group and from 0.57 ± 0.33 to 0.29 ± 0.34 (p < 0.001) in NLP group. Central retinal thickness decreased significantly from 514.5 ± 53.2 µm to 295.3 ± 11.3 µm (p < 0.001) and from 494.0 ± 111.2 µm to 285.8 ± 51.4 µm (p < 0.001) in CLP and NLP group, respectively. Total laser energy and number of laser burns applied per procedure in NLP group was statistically significantly lower than in CLP group (0.28 ± 0.13 J vs 0.59 ± 0.06 J, p < 0.001 and 28.5 ± 14.2 burns vs 48.9 ± 5.1 burns, respectively, p < 0.001). No adverse events related to laser treatment was noted in study groups during the follow-up. CONCLUSION This study demonstrated superiority of navigated laser photocoagulation compared to conventional laser photocoagulation in primary treatment of RAM which results from similar efficacy and safety of both techniques with lower mean total laser energy and number of laser burns required for navigated laser photocoagulation.
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Affiliation(s)
- Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, 5 Klinicheskaya St, St. Petersburg, Russia 194044
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, 5 Klinicheskaya St, St. Petersburg, Russia 194044
| | - Bhushan Uplanchiwar
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, 500 034 India
| | - Luiz H. Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, 500 034 India
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Huang N, Lee WA, Rivera S, Montezuma SR. Ruptured Retinal Arterial Macroaneurysm Secondary to Toxoplasmic Kyrieleis Arteriolitis: A Case Report. Case Rep Ophthalmol 2017; 8:390-395. [PMID: 28924434 PMCID: PMC5597918 DOI: 10.1159/000478720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/14/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this report was to describe multimodal ocular imaging findings in a patient who presented with a ruptured retinal arterial macroaneurysm (RAM) associated with toxoplasmic Kyrieleis arteriolitis. Methods We report the case of a 64-year-old man with a history of systemic hypertension and dense amblyopia of the left eye who presented with decreased vision and new floaters in the left eye. Color fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography were used as diagnostic imaging tools. Results No signs of hypertensive retinopathy were noted in the right eye. Multiple chorioretinal scars characteristic of previous toxoplasmosis were revealed in the left eye, with one covering most of the macula. Periarterial plaques or Kyrieleis arteriolitis were observed in retinal arteries surrounding the toxoplasmic retinal scars. Multiple RAMs were observed in these vessels, one of which was acutely ruptured. A perivenular plaque associated with a chronic branch retinal vein occlusion (BRVO) was noted along the same arcade at the arteriovenous crossing. Conclusion RAM formation and BRVO can present as possible long-term complications of toxoplasmic Kyrieleis arteriolitis. This is the first reported case demonstrating an association between toxoplasmic Kyrieleis arteriolitis and RAM formation.
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Affiliation(s)
- Natalie Huang
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.,Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Andrew Lee
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sean Rivera
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
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Kishore K. Long-Term Management of Complications of Retinal Artery Macroaneurysms with Intravitreal Aflibercept Injection. Case Rep Ophthalmol 2016; 7:162-171. [PMID: 27790133 PMCID: PMC5075728 DOI: 10.1159/000449122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report the 1-year follow-up results of intravitreal aflibercept injection (IAI) for the management of complications of retinal artery macroaneurysms (RAM). METHODS A retrospective, noncomparative, interventional case series of 4 eyes of 4 patients (all female, aged 68-91 years, 3 treatment naive) treated with IAI 2 mg for complications of RAM [macular edema (ME) 2, submacular hemorrhage (SMH) 1, and vitreous hemorrhage (VH) 1] was conducted. Baseline parameters consisted of complete ocular examination, medical history, best-corrected Snellen VA, fundus photography, IVFA and SD OCT, unless precluded by VH (1). All patients completed ≥1 year follow-up. RESULTS Baseline VA was hand motions in the eye with SMH (31 mm2 area and 1,478 μm thickness); 20/40 and 20/100 with ME (CST 390 and 337 μm, respectively), and 20/200 in the eye with VH. At 1 month, both patients with ME showed resolution of ME with CST <300 μm with improvement in VA which was maintained through 1 year. VH resolved in one eye at 1 month with no recurrence after 1 year. The eye with SMH developed macular scar and had counting fingers vision at 1 year. Thrombosis of RAM was noted in all eyes and hairpin-like remodeling of artery in one. No eye required repeat injection or laser. CONCLUSION ME and VH from RAM were effectively treated with IAI. However, the eye with thick SMH had poor visual outcome despite thrombosis of RAM. Single IAI provided effective therapy for complications of RAM with excellent anatomical and visual results in each eye, except one with thick SMH, and merits further study.
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Affiliation(s)
- Kamal Kishore
- University of Illinois College of Medicine, Peoria, Ill., USA
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Hughes EL, Dooley IJ, Kennelly KP, Doyle F, Siah WF, Connell P. Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms. Graefes Arch Clin Exp Ophthalmol 2016; 254:2203-2207. [PMID: 27221656 DOI: 10.1007/s00417-016-3388-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined. METHODS Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation. RESULTS Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40 % showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM. CONCLUSION Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.
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Affiliation(s)
- Emily L Hughes
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Ian J Dooley
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Kevin P Kennelly
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Fergus Doyle
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - W F Siah
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - P Connell
- Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Erol MK, Dogan B, Coban DT, Toslak D, Cengiz A, Ozel D. Intravitreal ranibizumab therapy for retinal arterial macroaneurysm. Int J Clin Exp Med 2015; 8:11572-11578. [PMID: 26379984 PMCID: PMC4565367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/22/2015] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the anatomic and functional results of intravitreal ranibizumab injection for treatment of symptomatic retinal arterial macroaneurysm (RAM). MATERIALS AND METHODS A series of seven patients (seven eyes) who had been diagnosed with symptomatic RAM were assessed by comprehensive ophthalmologic examination, fluorescein angiography (FA), optical coherence tomography (OCT), and indocyanine green angiography (ICGA). All patients were treated by intravitreal ranibizumab injection within one week of diagnosis and retreated upon evidence of persistent serous detachment or hemorrhage involving the macula on OCT. Anatomical recovery was examined by FA, OCT, and ICGA. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated using the Snellen chart and optical coherence tomography, respectively, at baseline; at 1, 3, and 6 months; and at the final visit. The BCVA and CMT values at baseline and the final visit were compared using the Wilcoxon signed rank test and determination of logarithm of the minimal angle of resolution (logMAR) of BCVA value. RESULTS Over a mean follow-up period of 10.86 ± 5.4 months, significant visual and anatomical recovery was observed, with visual acuity improving by three or more lines in all seven patients. The mean logMAR of BCVA improved from 1.09 ± 0.60 to 0.16 ± 0.16 (p = 0.018) and mean CMT decreased from 427.5 ± 132.4 μm to 208.7 ± 23.1 μm (P = 0.018). No complications were observed with intravitreal ranibizumab injection. CONCLUSION İntravitreal ranibizumab is an effective therapy for symptomatic RAM, improving BCVA and decreasing CMT.
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Affiliation(s)
- Muhammet Kazim Erol
- Department of Antalya Training and Research Hospital, Eye ClinicAntalya, Turkey
| | - Berna Dogan
- Department of Antalya Training and Research Hospital, Eye ClinicAntalya, Turkey
| | - Deniz Turgut Coban
- Department of Antalya Training and Research Hospital, Eye ClinicAntalya, Turkey
| | - Devrim Toslak
- Department of Antalya Training and Research Hospital, Eye ClinicAntalya, Turkey
| | - Ayse Cengiz
- Department of Antalya Training and Research Hospital, Eye ClinicAntalya, Turkey
| | - Deniz Ozel
- Department of Biostatistics and Medical Informatics of Akdeniz University Medical FacultyAntalya, Turkey
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Koinzer S, Heckmann J, Tode J, Roider J. Long-term, therapy-related visual outcome of 49 cases with retinal arterial macroaneurysm: a case series and literature review. Br J Ophthalmol 2015; 99:1345-53. [PMID: 25883085 DOI: 10.1136/bjophthalmol-2014-305884] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 03/21/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE Retinal arterial macroaneurysms (RAMAs) are acquired dilations of branches of the central retinal artery. Treatment depends on vision-limiting complications. We compare the long-term visual acuity (VA) in three groups according to treatment. METHODS 49 charts of patients with RAMA were reviewed. 16 remained untreated, 15 received photocoagulation and 18 vitrectomy. Patients underwent full ophthalmological examinations and up-to-date imaging. We evaluated chosen therapy, complications and final VA at the last visit. RESULTS 65% of the cohort was female, aged 75±11 years (mean±SD). Follow-up was 34±23 months. These parameters did not differ significantly between the three groups. In the observed group, initial VA was 0.48 (mean log MAR) vs 0.35 at the final visit, in the photocoagulation group 0.55 vs 0.59, and in the vitrectomy group 1.8 vs 0.77. VA was significantly worse at enrolment in the vitrectomy group, while all other VA differences were not significant. CONCLUSIONS The overall visual prognosis of RAMA was good, even after macular complications. VA remained unchanged in the observed and the laser groups and was comparable in all groups after 3 years. Based on an individual treatment decision, all therapies were effective and efficient. If subfoveal haemorrhage caused a macular hole, the VA outcome was limited.
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Affiliation(s)
- Stefan Koinzer
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Jan Heckmann
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
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Leung EH, Reddy AK, Vedula AS, Flynn HW. Serial bevacizumab injections and laser photocoagulation for macular edema associated with a retinal artery macroaneurysm. Clin Ophthalmol 2015; 9:601-9. [PMID: 25897199 PMCID: PMC4396452 DOI: 10.2147/opth.s80504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Ella H Leung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Ashvini K Reddy
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Anil S Vedula
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
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Kim H, Lee SC, Kim SM, Lee JH, Koh HJ, Kim SS, Byeon SH, Kim M, Lee CS. Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography. Ophthalmologica 2015; 233:146-54. [DOI: 10.1159/000380830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/08/2015] [Indexed: 11/19/2022]
Abstract
Purpose: To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA). Methods: Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups. Results: The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72). Conclusions: ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.
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Spontaneously resolved macroaneurysm associated with a congenital anomalous retinal artery. Retin Cases Brief Rep 2014; 4:70-2. [PMID: 25390126 DOI: 10.1097/icb.0b013e318196b2c8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To report the outcome of retinal artery macroaneurysm associated with a congenital anomalous retinal artery. METHODS The patient was examined with ophthalmoscopy and fluorescein angiography. RESULTS A 60-year-old woman presented with visual acuity of 20/80 in her right eye. She was found to have an abnormal retinal vessel emerging from the optic disk, passing toward the center of the macula, and looping back toward the disk. The center of the loop had a leaking macroaneurysm, which was treated conservatively. At the 4-month follow-up visit, the visual acuity in the right eye had improved to 20/20 with resolution of most of the macular edema, exudates, and hemorrhage. CONCLUSION This case demonstrates that retinal artery macroaneurysm can be successfully managed with a conservative approach, even when associated with a congenital anomalous retinal vessel.
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20
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Laser therapy versus observation for symptomatic retinal artery macroaneurysms. Graefes Arch Clin Exp Ophthalmol 2014; 253:537-41. [PMID: 25016479 DOI: 10.1007/s00417-014-2730-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/22/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The optimal management approach to retinal arterial macroaneurysms (RAM) is unknown. This paper compares long-term outcomes in RAM treated with laser therapy versus observation. METHODS This is an IRB-approved retrospective study of patients with symptomatic RAM. Charts of patients with a diagnosis of RAM causing symptomatic visual loss were reviewed. Patients with less than 6 months follow up, other confounding diagnoses, or additional therapy beyond thermal laser were excluded. Statistical analysis was done using χ(2) or Student's t test as appropriate. RESULTS Forty-eight patients with RAM were identified and 27 were included in the study (13 treated, 14 observed). Mean visual acuity in the observation group improved from 20/120 to 20/96 (p = 0.53) compared to 20/280 to 20/54 (p = 0.0003) in the treated group. Subgroup analysis showed that visual acuity in primarily hemorrhagic lesions treated with laser therapy improved by 1.21 logMAR compared to a loss of 0.11 logMAR (p = 0.002) in those that were observed. In primarily exudative lesions, both treated and observed lesions showed an improvement of 0.32 logMAR. No patients in the treatment group had a final visual acuity below 20/200 compared to four in the observation group. CONCLUSION Treatment with direct laser photocoagulation was associated in this study with greater improvement in visual acuity and may decrease the risk of severe visual loss especially in primarily hemorrhagic RAM lesions. Compared to observation alone.
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21
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Speilburg AM, Klemencic SA. Ruptured retinal arterial macroaneurysm: diagnosis and management. JOURNAL OF OPTOMETRY 2014; 7:131-137. [PMID: 25000868 PMCID: PMC4087178 DOI: 10.1016/j.optom.2013.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 06/03/2023]
Abstract
Retinal arterial macroaneurysm is an acquired, focal dilation of a retinal artery, typically occurring within the first three bifurcations of the central retinal artery. The clinical presentation of a retinal arterial macroaneurysm is highly variable, making initial diagnosis difficult and differentials many. Identification of retinal arterial macroaneurysms is crucial to appropriately co-manage with the primary care physician for hypertension control. Prognosis is generally good and observation is often an adequate treatment. However, in cases of macular threat or involvement, some treatment options are available and referral to a retinal specialist is indicated.
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Affiliation(s)
- Ashley M Speilburg
- Illinois College of Optometry/Illinois Eye Institute, 3241 S. Michigan Avenue, Chicago, IL 60616, United States.
| | - Stephanie A Klemencic
- Illinois College of Optometry/Illinois Eye Institute, 3241 S. Michigan Avenue, Chicago, IL 60616, United States
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Pitkänen L, Tommila P, Kaarniranta K, Jääskeläinen JE, Kinnunen K. Retinal arterial macroaneurysms. Acta Ophthalmol 2014; 92:101-4. [PMID: 23800325 DOI: 10.1111/aos.12210] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Retinal arterial macroaneurysms are acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. They are associated with systemic vascular conditions such as hypertension and arteriosclerotic disease occurring most commonly in elderly women. The primary reported symptom is a sudden loss of vision due to haemorrhage or oedema affecting the macula. Most of macroaneurysms regress without treatment and without causing decreased visual acuity. Poor visual outcome may occur secondary to foveal exudates and subfoveal haemorrhage.
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Affiliation(s)
- Leena Pitkänen
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, FinlandDepartment of Ophthalmology, Kuopio University Hospital, Kuopio, FinlandDepartment of Ophthalmology, Helsinki University Hospital, Helsinki, FinlandDepartment of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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Intravitreal bevacizumab for symptomatic retinal arterial macroaneurysm. Am J Ophthalmol 2013; 155:898-904. [PMID: 23385203 DOI: 10.1016/j.ajo.2012.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the therapeutic effect of intravitreal bevacizumab injection for symptomatic retinal arterial macroaneurysm. DESIGN Retrospective interventional case series. METHODS The study included 23 patients (23 eyes) with symptomatic retinal arterial macroaneurysm. They were categorized according to treatment method into 2 groups: an intravitreal bevacizumab-treated group (11 eyes) and an untreated group (12 eyes). Bevacizumab was injected at the initial visit, followed by as-needed monthly reinjection. Best-corrected visual acuity (BCVA) and central macular thickness were documented and analyzed between groups. RESULTS The mean follow-up period for all subjects was 10.83 ± 4.6 months. The mean number of injections for the treated group was 1.42 ± 0.69. The mean logarithm of the minimal angle of resolution (logMAR) of BCVA improved from baseline at the last follow-up by 0.26 in the bevacizumab-treated group (P = .02) and by 0.34 in the untreated group (P = .005). Average central macular thickness decreased from 384.4 ± 150.1 μm to 265 ± 112.5 μm in the bevacizumab-treated group (P = .0002) and from 413.2 ± 155.2 μm to 236.3 ± 103.5 μm in the untreated group (P = .008). The BCVA was significantly improved from baseline after 1 month in the bevacizumab-treated group (P = .02) and after 3 months in the untreated group (P = .01). However, there was no statistically significant difference in BCVA improvement or central macular thickness improvement achieved at the final visit. CONCLUSIONS Intravitreal bevacizumab injection likely hastens resolution of macular edema and hemorrhage secondary to retinal arterial macroaneurysm. Intravitreal bevacizumab injection could be an effective treatment option for symptomatic retinal arterial macroaneurysm.
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Pichi F, Morara M, Torrazza C, Manzi G, Alkabes M, Balducci N, Vitale L, Lembo A, Ciardella AP, Nucci P. Intravitreal bevacizumab for macular complications from retinal arterial macroaneurysms. Am J Ophthalmol 2013; 155:287-294.e1. [PMID: 23111179 DOI: 10.1016/j.ajo.2012.07.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/27/2012] [Accepted: 07/31/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the anatomic and functional results of the treatment with intravitreal bevacizumab in complicated retinal arterial macroaneurysm (RAM). DESIGN A multicenter interventional, prospective, nonrandomized study. METHODS Thirty-eight macroaneurysms of 37 patients with foveal complications were evaluated. All patients underwent a comprehensive ophthalmologic examination, fluorescein angiography (FA), and spectral-domain optical coherence tomography (SD OCT) examination. Each patient underwent 3 monthly injections of bevacizumab 1.25 mg/0.05 mL; 3 follow-up visits were planned at week 2, 6, and 12. RESULTS Both best-corrected visual acuity (BCVA), expressed in logarithm of minimal angle of resolution (logMAR), and central retinal thickness (CRT) significantly improved during the follow-up visits (0.57 ± 0.21 vs 0.41 ± 0.15 vs 0.23 ± 0.13 vs 0.09 ± 0.10 and 520.38 ± 191.05 vs 396.24 ± 136.18 vs 283.86 ± 71.87 vs 214.84 ± 26.86, respectively, Friedman test P < .0001 for all variables). At 6 weeks of follow-up, FA showed complete closure of the RAM in 36 of 38 cases (94.7%). Four weeks following the third injection, the macular edema had completely resolved and hard exudates regressed slowly in 100% of patients. CONCLUSIONS Intravitreal bevacizumab is an effective therapy for complicated RAM, quickly improving BCVA and CRT. Anti-vascular endothelial growth factor (VEGF) drugs might actively close the involved pathologically permeabilized retinal artery and normalize the vessel wall formation by localized inhibition of VEGF.
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Moon SJ, Kim SW, Kim HS, Kang JH, Yoon HS. Intravitreal Bevacizumab for Macular Edema Secondary to Ruptured Retinal Arterial Macroaneurysm. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.4.522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Ho Soong Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Golan S, Goldenberg D, Goldstein M. Long-term follow-up of intravitreal bevacizumab in retinal arterial macroaneurysm: a case report. Case Rep Ophthalmol 2011; 2:387-91. [PMID: 22220164 PMCID: PMC3250664 DOI: 10.1159/000334788] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To present the long-term effect of intravitreal bevacizumab (Avastin®) therapy in a patient suffering from retinal arterial macroaneurysm. Methods Case report of a 72-year-old female diagnosed with retinal macroaneurysm in the superior temporal artery leading to macular edema. Functional and morphological data at baseline, 4 weeks, 2 months, and 13 months following treatment with two consecutive intravitreal bevacizumab injections are presented. Results Best-corrected visual acuity improved from 20/160 at baseline to 20/20 at the 3-months follow-up and remained stable through 13 months of follow-up. Central retinal thickness measured by optical coherence tomography decreased from 364 μm at baseline to 248 μm at the 13-months follow-up. No ocular or systemic side effects were detected. Conclusions Intravitreal bevacizumab therapy may lead to resolution of macular edema associated with retinal macroaneurysm and consequently visual improvement. This treatment may promise a long-lasting effect but warrant further investigation in larger series.
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Affiliation(s)
- Shani Golan
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel-Aviv, Israel
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Abstract
Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.
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Affiliation(s)
- M Bhargava
- Singapore Eye Research Institute, National University of Singapore, Singapore
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Yannuzzi LA. A case for the case report and case series in evidence-based management of retinal disease. Retin Cases Brief Rep 2011; 5:97-103. [PMID: 25389873 DOI: 10.1097/icb.0b013e31821b5daf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Lawrence A Yannuzzi
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear & Throat Hospital, New York, New York
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Wenkstern AR, Petersen H. Intravitreal ranibizumab in retinal macroaneurysm. Graefes Arch Clin Exp Ophthalmol 2010; 248:1667-70. [DOI: 10.1007/s00417-010-1380-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 03/27/2010] [Accepted: 04/02/2010] [Indexed: 11/28/2022] Open
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Retinal arterial macroaneurysm causing multilevel retinal hemorrhage. OPTOMETRY (ST. LOUIS, MO.) 2009; 80:425-30. [PMID: 19635433 DOI: 10.1016/j.optm.2008.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 11/14/2008] [Accepted: 12/13/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Retinal arterial macroaneurysms are focal dilatations of the retinal arteries that present with varying degrees of retinal hemorrhage or exudation. They are most often associated with hypertension and may masquerade as many other retinal conditions. CASE REPORT A hypertensive 59-year-old man presented to the clinic with a sudden onset of painless vision loss in the left eye. Best-corrected visual acuities were 20/20 in the right eye and counting fingers at 3 feet with eccentric viewing in the left. Dilated fundus examination found a multilevel retinal hemorrhage involving most of the superior arcade and extending into the macular area. A diagnosis of retinal arterial macroaneurysm was given after fluorescein angiography and evaluation by a retina specialist. Hemorrhage resolved without treatment, and visual acuity returned to 20/25 by the 6-month follow-up visit. CONCLUSIONS Optometrists should be aware of presenting signs and symptoms associated with retinal macroaneurysms as well as the many differentials and possible treatments. Given the high incidence of associated systemic disease, proper knowledge of necessary systemic workup is also critical.
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Abstract
BACKGROUND Retinal arteriolar macroaneurysms typically involve the second and third order arterioles. Macroaneurysms involving the first order arterioles, specifically overlying the optic nerve, have been infrequently reported. METHODS This is a retrospective case series. RESULTS Two patients were found to have an arteriolar macroaneurysm overlying the optic nerve. The first, a 77-year-old man, had focal laser photocoagulation to the macroaneurysm. The second, a 75-year-old woman, had spontaneous resolution of the lesion without treatment. Final visual acuity was 20/25 in the treated patient compared to 20/80 in the untreated patient. CONCLUSION Retinal arteriolar macroaneurysms overlying the optic nerve will involute spontaneously or as a result of focal laser photocoagulation. The associated macular edema may result in permanent visual loss. Focal laser treatment over the optic nerve did not cause optic nerve damage.
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Contreras JE, Mieler WF, Mittra RA, Pollack JS, Jiyamapa J. Retinal Arterial Macroaneurysms. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Hypertension has a range of effects on the eye. Hypertensive retinopathy refers to retinal microvascular signs that develop in response to raised blood pressure. Signs of hypertensive retinopathy are frequently seen in adults 40 years and older, and are predictive of incident stroke, congestive heart failure, and cardiovascular mortality--independently of traditional risk factors. Hypertension is also a major risk factor for the development of other retinal vascular diseases, such as retinal vein and artery occlusion, and ischaemic optic neuropathy. High blood pressure increases the risk of both development of diabetic retinopathy and its progression. Adequate control of blood pressure has been proven in randomised clinical trials to reduce vision loss associated with diabetic retinopathy. Finally, hypertension has been implicated in the pathogenesis of glaucoma and age-related macular degeneration. Recognition of the ocular effects of blood pressure could allow physicians to better manage patients with hypertension, and to monitor its end-organ effects.
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Affiliation(s)
- Tien Yin Wong
- Centre for Eye Research Australia, University of Melbourne, Australia.
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Oie Y, Emi K. Surgical Excision of Retinal Macroaneurysms with Submacular Hemorrhage. Jpn J Ophthalmol 2006; 50:550-553. [PMID: 17180532 DOI: 10.1007/s10384-006-0369-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 04/03/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the visual outcome following the surgical excision of retinal macroaneurysms with submacular hemorrhage. METHODS Two patients presented with decreased vision caused by submacular hemorrhage from retinal macroaneurysms. In the first case, the macroaneurysm was too large to be treated by photocoagulation, and in the second case the direct photocoagulation during the first vitrectomy did not prevent the recurrence of hemorrhages. Vitrectomy with surgical excision of the retinal macroaneurysm using scissors and diathermy with a drainage of the submacular hemorrhage was then performed. RESULTS In the first patient, the visual acuity was light perception before treatment and 2/200 16 months after the excision. In the second patient, the visual acuity was 20/667 before treatment and 20/40 11 months after the excision. No hemorrhage has recurred in either case after the second vitrectomy. CONCLUSIONS The surgical excision of retinal macroaneurysms might be an effective procedure in cases where the macroaneurysm is too large or cannot be treated by photocoagulation during vitrectomy.
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Affiliation(s)
- Yoshinori Oie
- The Department of Ophthalmology, Osaka Rosai Hospital, Osaka, Japan.
| | - Kazuyuki Emi
- The Department of Ophthalmology, Osaka Rosai Hospital, Osaka, Japan
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Grosso A, Wong TY. Ocular manifestations of systemic arterial hypertension. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Takahashi K, Kishi S. Serous Macular Detachment Associated with Retinal Arterial Macroaneurysm. Jpn J Ophthalmol 2006; 50:460-464. [PMID: 17013700 DOI: 10.1007/s10384-006-0347-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 04/14/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To report optical coherence tomography (OCT) findings of macular edema secondary to retinal arterial macroaneurysms. METHODS Six eyes with retinal arterial macroaneurysms were retrospectively examined by OCT. All eyes had macular edema without massive macular hemorrhage. Fluorescein angiography was performed in six eyes, and indocyanine green angiography was done in four eyes. Five eyes underwent direct laser photocoagulation to the retinal arterial macroaneurysms. The foveal thickness, height of the serous macular detachment, and visual acuity (VA) were evaluated from the initial examination until the macular edema resolved. RESULTS In all six eyes, the macular edema secondary to retinal arterial macroaneurysms comprised a serous macular detachment with retinal swelling. No cystoid macular edema was observed in any eyes. Dye leakage occurred only from the macroaneurysms in all eyes. OCT showed complete resolution of the serous macular detachment and retinal swelling 1 to 4 months after the initial examination. Macular hard exudates developed during absorption of the serous macular detachment in all eyes. VA improved more than two lines in all eyes after the macular edema resolved. CONCLUSION Retinal arterial macroaneurysms may leak extravasated fluid into the subretinal space, which may result in a serous macular detachment.
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Affiliation(s)
- Kyoichi Takahashi
- Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Gunma, Japan
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Yang CS, Tsai DC, Lee FL, Hsu WM. Retinal Arterial Macroaneurysms: Risk Factors of Poor Visual Outcome. Ophthalmologica 2005; 219:366-72. [PMID: 16286797 DOI: 10.1159/000088380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 02/11/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the long-term natural course and to identify the risk factors of a poor visual outcome in patients with retinal arterial macroaneurysms (MA). METHODS In this observational case series, we retrospectively evaluated the consecutive patients with MA at our institution over a 17-year period. The visual outcomes of the different types of MA (presented as predominantly hemorrhagic or exudative) were compared. RESULTS A total of 31 patients with 46 confirmed MA were identified. The ocular manifestations of MA included retinal hemorrhage (96.7%), retinal exudate (61.3%), macular involvement (77.4%) and vitreous hemorrhage (12.9%). Among the 10 cases of hemorrhagic-type MA, visual acuity improved by 2 or more lines in 9 (90%) and decreased in 1 patient (10%). In the 15 cases of exudative-type MA, 4 improved (26.7%), 8 remained stationary (53.3%) and 3 had decreased visual acuity (20.0%). The average vision change in the minimum angle of resolution improved by 0.59 log units in hemorrhagic MA and decreased by 0.07 log units in exudative MA (p < 0.01). With respect to change of vision, the eyes with hemorrhagic-type MA showed greater improvement than those with the exudative type, but the final visual outcome was not different in the 2 groups. Foveal exudate was a statistically significant risk factor for final vision equal to or worse than 6/30 (odds ratio = 6.93, p < 0.05). CONCLUSIONS Different types of MA may have different clinical presentations. In the majority of MA, there is gradual and spontaneous involution. However, poor visual outcome may occur secondary to foveal exudates and subfoveal hemorrhage.
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Affiliation(s)
- Chang-Sue Yang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taiwan, Republic of China.
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Moosavi RA, Fong KCS, Chopdar A. Retinal artery macroaneurysms: clinical and fluorescein angiographic features in 34 patients. Eye (Lond) 2005; 20:1011-20. [PMID: 16138114 DOI: 10.1038/sj.eye.6702068] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To describe the clinical and fluorescein angiographic features of patients with macroaneurysms (MAs) attending an ophthalmology department over 8 years. METHODS All the patients between 1997 and 2004 with a diagnosis of retinal artery MA were identified from hospital records. Photographs and fluorescein angiograms were examined, and the MAs classified according to their clinical (haemorrhagic or exudative) features, and angiographic (saccular or fusiform) features. Baseline data of the patients were taken including visual acuity and associated ocular and medical conditions. RESULTS A total of 38 MAs were identified in 34 patients. The age at presentation ranged from 36 to 93 years, with a mean of 73.7 years. Of them, 24/34 (70%) were female patients, and 10/34 (30%) were male patients. There was a history of hypertension in 9/14 patients (64.3%). Of 38 MAs, 32 were identifiable as either saccular or fusiform. Of these, 22/32 (68.75%) were saccular, the rest fusiform. In all, 72.7% of the saccular MAs showed haemorrhage as the predominant feature. Of the 10 fusiform MAs, 90% showed haemorrhage as the predominant feature. CONCLUSION Retinal artery macroaneurysm is a rare condition that may mimic a variety of other conditions. Most MAs do not require treatment. We suggest guidelines for diagnosis and propose a treatment algorithm for this condition.
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Affiliation(s)
- R A Moosavi
- Ophthalmology Department, East Surrey Hospital, Redhill, Surrey, RH1 5RH, UK.
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Wu TT, Sheu SJ. Intravitreal Tissue Plasminogen Activator and Pneumatic Displacement of Submacular Hemorrhage Secondary to Retinal Artery Macroaneurysm. J Ocul Pharmacol Ther 2005; 21:62-7. [PMID: 15718829 DOI: 10.1089/jop.2005.21.62] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the efficacy of treating submacular hemorrhages secondary to retinal arterial macroaneurysm with intravitreous tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS Six consecutive patients (6 eyes) with submacular hemorrhage secondary to retinal arterial macroaneurysm were included in this study. Tissue plasminogen activator, at a dose of 50 microg/0.1 mL, was injected through the pars plana into the vitreous cavity. Gas (0.3-0.5 mL of perfluoropropane) instillation followed tPA injection, either immediately after injection or sometime during the next day. RESULTS Best postoperative visual acuity improved in 5 of 6 eyes (83%) and was unchanged in 1 of 6 (17%) eyes. In 5 of 6 (83%) eyes, the procedure resulted in complete or partial displacement of submacular hemorrhage out of the foveal area. CONCLUSIONS Intravitreous injection of tPA and gas, followed by prone positioning of the patient, is an effective and simple treatment of submacular hemorrhage secondary to retinal arterial macroaneurysm. No complication occurred in this series.
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Affiliation(s)
- Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
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Zhao P, Hayashi H, Oshima K, Nakagawa N, Ohsato M. Vitrectomy for macular hemorrhage associated with retinal arterial macroaneurysm. Ophthalmology 2000; 107:613-7. [PMID: 10711904 DOI: 10.1016/s0161-6420(99)00127-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of pars plana vitrectomy to treat massive macular hemorrhage caused by retinal arterial macroaneurysm. DESIGN Retrospective case series. PARTICIPANTS Eight eyes of eight patients. METHODS We retrospectively reviewed the charts for eight eyes of eight patients in which pars plana vitrectomy had been performed to remove a massive macular hemorrhage secondary to a ruptured retinal arterial macroaneurysm. In each case, the preretinal/intralamellar hemorrhage was removed, and in three of the eight eyes a subretinal hemorrhage was removed via a retinotomy after clot lysis using tissue plasminogen activator. MAIN OUTCOME MEASURE Pars plana vitrectomy to treat macular hemorrhage secondary to retinal arterial macroaneurysm. RESULTS The duration of symptoms ranged from 10 to 80 days (average, 31 days). The preoperative visual acuities ranged from counting fingers to 0.09. Follow-up ranged from 3 to 36 months (average, 19 months). The postoperative visual acuities improved in seven eyes and remained unchanged in one; vision was better than 0.1 in six eyes and better than 0.4 in five. Postoperative complications included a mild vitreous hemorrhage in two eyes, a macular hole in one, and a cataract in two. CONCLUSIONS Pars plana vitrectomy appears to be relatively safe and effective in treating massive macular hemorrhage caused by a retinal arterial macroaneurysm.
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Affiliation(s)
- P Zhao
- Department of Ophthalmology, School of Medicine, Fukuoka University, Japan
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Townsend-Pico WA, Meyers SM, Lewis H. Indocyanine green angiography in the diagnosis of retinal arterial macroaneurysms associated with submacular and preretinal hemorrhages: a case series. Am J Ophthalmol 2000; 129:33-7. [PMID: 10653410 DOI: 10.1016/s0002-9394(99)00337-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the use of indocyanine green angiography in the diagnosis of retinal arterial macroaneurysms associated with preretinal and subretinal hemorrhage. METHODS Retrospective case series. Indocyanine green angiograms of five consecutive patients with dense preretinal, intraretinal, and subretinal hemorrhages in which the cause of hemorrhage was still in question after clinical evaluation and fluorescein angiography. RESULTS In five eyes of five patients, indocyanine green angiography demonstrated acquired retinal arterial macroaneurysms as the cause of hemorrhage. Each diagnosis was confirmed after the hemorrhages spontaneously resolved or were surgically removed. CONCLUSIONS Indocyanine green angiography is useful in the diagnosis of acquired retinal arterial macroaneurysms when fluorescein angiography is inconclusive because of preretinal, intraretinal, or subretinal hemorrhage. Establishing the diagnosis of retinal arterial macroaneurysm can influence the management of patients with submacular and premacular hemorrhage.
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Cahill MT, Flitcroft DI, Acheson RW. Fundal findings preceding retinal artery macroaneurysm. Eye (Lond) 1999; 12 ( Pt 6):1023-4. [PMID: 10326012 DOI: 10.1038/eye.1998.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Thurairajan G, Potamitis T, Naylor G, Gibson J. Carotid artery Doppler ultrasonography in retinal macroaneurysms. Eye (Lond) 1998; 12 ( Pt 1):61-3. [PMID: 9614519 DOI: 10.1038/eye.1998.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It is postulated that retinal arterial macroaneurysms (RAMs) occur at the site of incomplete embolic occlusion of a branch retinal artery. Embolic events of the retinal vessels are related to the state of the carotid artery tree and therefore Doppler ultrasonography of the carotid arteries in these patients is of particular interest. We have examined 13 patients with retinal artery macroaneurysms with carotid artery Doppler ultrasonography (CADU). Eight of these patients (61.5%) exhibited atheromatous plaques on the same side as the RAM with a moderate degree of arterial narrowing. Although our group of patients did not show advanced carotid artery disease, alterations of the arterial wall found at the level of the carotid artery were higher than expected in a similar hypertensive population. To our knowledge this is the first study of the carotid arterial tree in these patients. Our results support the theory that RAMs may be of embolic origin. Furthermore they demonstrate that CADU is a useful investigation in patients with RAMs.
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Affiliation(s)
- G Thurairajan
- Birmingham and Midland Eye Centre, City Hospital NHS Trust
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