Capillary macroaneurysms in central retinal vein occlusion

Focal Photocoagulation as an Adjunctive Therapy to Reduce the Burden of Intravitreal Injections in Macula Edema Patients, the LyoMAC2 Study

AIM

To assess the efficacy of focal photocoagulation of capillary macroaneurysms (CMA) to reduce the burden of intravitreal injections (IVI) in patients with macular edema (ME).

MATERIALS AND METHODS

Retrospective multicenter study in patients with diabetic ME or ME secondary to retinal vein occlusion (ME-RVO). CMA associated with ME were selectively photocoagulated. Patients were followed for one year after photocoagulation.

RESULTS

93 eyes of 76 patients were included in this study. At 6 months after the laser (n = 93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 2.52 to 1.52 at 6 months, p < 0.001). The mean BCVA remained stable (0.32 and 0.31 logMAR at baseline and 6 months, p = 0.95). At 12 months (n = 81/93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 4.44 to 2.95 at 12 months, p < 0.001), while the mean BCVA remained stable (0.32 and 0.30 logMAR at baseline and 12 months, p = 0.16).

CONCLUSION

Focal laser photocoagulation of CMA seems to be effective and safe for reducing the burden of IVI in patients with ME. Their screening during the follow-up should be considered closely.

Screening of telangiectatic capillaries in chronic macular edema based on multimodal imaging: a study of 101 eyes. LyoMAC1 study

PURPOSE

To estimate the prevalence of telangiectatic capillaries (TCs) in patients followed for chronic macular edema (CME) (diabetic ME [DME] and ME associated with retinal vein occlusion [RVO]).

METHODS

Real-life, prospective, bi-centric cohort study including all consecutive patients followed for a clinically significant CME secondary to diabetic retinopathy or RVO. Inclusion criteria were patients treated with intravitreal injection for their ME for at least 12 months who had to undergo follow-up angiography. Multimodal imaging with color retinophotography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography, and en face OCT was performed in all patients.

RESULTS

A total of 101 eyes of 71 patients were included between November 2019 and June 2020. Of the 101 eyes analyzed, indocyanine green angiography found at least one TC in 67 eyes (66.3%). No significant differences were found between the groups with and without TC except for the distribution of DME and RVO (p < 0.008). In 83.6% of eyes with TCs, TCs contributed to the formation of the ME. SD-OCT sensitivity for TC detection was 94%.

CONCLUSION

In our study, the estimated prevalence of TCs in CME (DME and ME associated with RVO) was 66.3%, i.e., two-thirds of patients. SD-OCT was an excellent screening examination with a sensitivity of 94%.

Subretinal leakage of a retinal capillary macroaneurysm - a case report

BACKGROUND

Report a rare case of retinal capillary macroaneurysm with associated subretinal fluid.

CASE PRESENTATION

A 71-year-old male underwent full ophthalmic examination including Optical Coherence Tomography (OCT), Fluorescein Angiography (FA). Fundus examination showed moderate non-proliferative diabetic retinopathy of both eyes with scattered microaneurysms. On initial visit, FA displayed a hyperfluorescent lesion with leakage on late frames in the left eye. OCT revealed the lesion to be spheroid with a hyperreflective wall and hyporeflective lumen in the inner retina, corresponding to a capillary macroaneurysm. Intraretinal cystic fluid surrounded the lesion. On subsequent visit 7 months later, subretinal fluid in the location of the capillary macroaneurysm was noted on OCT. Vision was maintained at 20/30-2 OD, 20/40 OS throughout. No treatment was necessary.

CONCLUSION

Subretinal fluid from the capillary macroaneurysm likely developed from its juxtafoveal location and discontinuity of the external limiting membrane (ELM); a barrier preventing flow of intraretinal fluid to the outer retina.

Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema

AIMS

During diabetic macular oedema (DME), a spectrum of capillary abnormalities is commonly observed, ranging from microaneurysms to large microvascular abnormalities. Clinical evidence suggests that targeted photocoagulation of large microvascular abnormalities may be beneficial, but their detection is not done in a routine fashion. It was reported that they are better identified by indocyanine green angiography (ICGA) than by fluorescein angiography. Here, we investigated the prevalence and ICGA and optical coherence tomography (OCT) features of retinal microvascular abnormalities in a group of patients with DME.

METHODS

Observational study. The fundus photographs, ICGA and structural and angiographic OCT charts of 35 eyes from 25 consecutive patients with DME were reviewed.

RESULTS

22 eyes (63%) had at least one focal area of microvascular abnormalities showing prolonged indocyanine green (ICG) staining (ie, beyond 10 mins after injection). In particular, all eyes (n=9) with circinate hard exudates showed foci of late ICG staining. These areas were either isolated globular capillary ecstasies or a cluster of ill-defined capillary abnormalities. They were located at a median distance of 2708 µm from the fovea (range: 1064-4583 µm). Their diameter ranged from 153 to 307 µm. During ICGA, 91% showed increased their contrast and apparent size in late frames, whereas 79% of microaneurysms showed reduced contrast on late frames. OCT angiography was not contributive for the detection of these lesions.

CONCLUSION

Late ICG staining revealing large microvascular abnormalities is commonly observed during DME. Because of their specific angiographic and OCT features relative to microaneurysms, we propose to name them telangiectatic capillaries (TelCaps).

Branch retinal vein occlusion and macroaneurysms

BACKGROUND

Macroaneurysms can represent common consequences of branch retinal vein occlusion (BRVO). The aim of the present study is to evaluate the clinical and angiographic aspects of 31 cases of branch retinal vein occlusions (BRVO) in which retinal macroaneurysms developed, in an attempt to analyze their pathogenic features.

METHODS

One hundred and sixty-one consecutive patients affected by BRVO were considered. Each patient underwent an opthalmological examination including fluorescein angiography, at an average interval of two months (range: 1-4 months) from the onset of the disease, with a mean follow-up of 43 months (range: 32-56 months). The macroaneurysms were subdivided according to size into small (from 100 to 149 microns), medium (from 150 to 249 microns), and large (greater than 250 microns), and according to origin into arterial, venous, capillary and collateral-associated.

RESULTS

Thirty-one patients (19.3%) developed retinal macroaneurysms. The total number of detected macroaneurysms was 51; ten (19.6%) were large, 21 (41.2%) were of medium-size and 20 (39.2%) were small in dimension. Three lesions were of arterial origin, 22 were capillary and 26 were from collateral vessels. In 27 patients (87.1%) the lesions were located outside the macular region, and in 4 patients (12.9%) in the macular region. Patients with retinal macroaneurysms did not show a different prevalence of capillary non-perfusion when compared with others. With regard to the number of retinal venous collaterals patients with macroaneurysms developed fewer than other patients, and the difference was statistically significant (p < 0.001).

CONCLUSION

The insufficient number of retinal venous collaterals can be considered the most contributory factor in the development of macroaneurysms secondary to BRVO.