Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience

• Published in: International ophthalmology Vol. 42; no. 2; pp. 497 - 507
• Main Authors: Khadka, Deepak, Tsaousis, Konstantinos T., Shrestha, Arjun, Suwal, Barsha, Shrestha, Nirsara, Sharma, Samata, Suwal, Rinkal, Khatri, Bijay
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-02-2022; Springer Nature B.V
• Subjects: Acuity; Aneurysm - diagnosis; Aneurysm - surgery; Angiogenesis Inhibitors - therapeutic use; Bevacizumab; Bevacizumab - therapeutic use; Edema; Exudates; Exudation; Eye; Eye (anatomy); Fovea; Humans; Hypertension; Intravitreal Injections; Lasers; Medicine; Medicine & Public Health; Middle Aged; Monoclonal antibodies; Neodymium lasers; Ophthalmology; Original Paper; Patients; Ranibizumab; Retina; Retinal Artery; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A; Visual Acuity; Hypertension; Intravitreal bevacizumab; Anti-vascular endothelial growth factor; Focal laser; PPV; Nd: Yag laser hyaloidotomy; Superotemporal
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-021-02066-8

Purpose
To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients.
Method
Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria.
Result
Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case.
Conclusion
With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.