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Intravitreal Anti-Vascular Endothelial Growth Factor for Macular Edema due to Complex Retinal Arterial Macroaneurysms
Caroline Bormann1,2, Jens Heichel2, Ute Hammer1
1aAugenzentrum "Frohe Zukunft", Halle (Saale), Germany.
Introduction:
Complex retinal arterial macroaneurysms (RAM) are often accompanied by hemorrhage and/or affect the macula. We evaluated the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy using ranibizumab or aflibercept with or without laser photocoagulation in the treatment of macular edema due to RAM.
Methods:
A case report of two patients with secondary macular edema caused by RAM is presented. The first case was a 76-year-old female treated with two 0.5-mg injections of ranibizumab and additional focal laser photocoagulation. This patient presented a solely intraretinal exudation. The second patient was a 96-year-old female, who received one 2.0-mg injection of aflibercept. She showed sub- and intraretinal edema. We documented the clinical courses of these patients based on fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography. Patients were followed-up for 12 months.
Results:
Patients were treated successfully using anti-VEGF therapy (ranibizumab or aflibercept) with or without laser photocoagulation. In both cases, we observed a complete regression of the macular edema and an increase in visual acuity.
Conclusion:
RAM can manifest with heterogeneous findings. Intravitreal anti-VEGF therapy with or without laser photocoagulation may be an effective treatment option in cases of macular edema due to RAM. Aflibercept and ranibizumab seem to be a potent anti-VEGF therapy for RAM. Individualized patient care is needed.
Insights
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, with or without laser photocoagulation, effectively treated macular edema caused by retinal arterial macroaneurysms (RAM). Both ranibizumab and aflibercept improved visual acuity and resolved edema in patients.
Area of Science:
- Ophthalmology
- Retinal Vascular Diseases
- Medical Treatments
Background:
- Retinal arterial macroaneurysms (RAM) can lead to vision-threatening macular edema.
- Evaluating the efficacy of anti-vascular endothelial growth factor (anti-VEGF) agents in managing RAM-induced macular edema is crucial.
Observation:
- A case report details two patients with macular edema secondary to RAM.
- One patient received ranibizumab with laser photocoagulation; the other received aflibercept monotherapy.
- Both patients exhibited distinct macular edema presentations, including intraretinal exudation and sub- and intraretinal fluid.
Findings:
- Successful treatment of macular edema in both cases using anti-VEGF therapy (ranibizumab or aflibercept), with or without laser photocoagulation.
- Complete regression of macular edema and significant improvement in visual acuity were observed in both patients.
- The study highlights the potential of aflibercept and ranibizumab as potent therapeutic options for RAM.
Implications:
- Intravitreal anti-VEGF therapy represents a viable treatment strategy for macular edema associated with RAM.
- The findings suggest that individualized treatment approaches, potentially combining anti-VEGF agents with laser photocoagulation, are beneficial.
- Further research may elucidate optimal treatment protocols for RAM-related complications.
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