Direct navigated laser photocoagulation as primary treatment for retinal arterial macroaneurysms

Abstract

ObjectivesTo compare the efficacy and safety of conventional and navigated laser photocoagulation as the primary treatment option for retinal arteriolar macroaneurysm (RAM).MethodsEleven (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.ResultsAt 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.ConclusionThis 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.

Intravitreal ranibizumab or conbercept for retinal arterial macroaneurysm: a case series

“…Thus, early intervention is recommended, especially in cases with foveal involvement. The most common treatment is direct argon laser photocoagulation at the site of RAM, but with several complications, such as possible retinal traction, an increase in retinal exudation, and enlargement of the laser scar, which limit the use in the clinical practice to some extent [11, 12]. Other therapeutic options include pneumatic displacement of tissue by a plasminogen activator, surgical removal of the associated hemorrhage with vitrectomy, and photodisruption of the internal limiting membrane or the posterior hyaloid to release the hemorrhage [11].…”

Zastosowanie laseroterapii w chorobach siatkówki. Część III

“…Maltsev opublikował wyniki badania, w którym uznaje bezpośrednią/nawigowaną fotokoagulację laserową za opcję w leczeniu objawowego makrotętniaka tętnicy siatkówki, niemającą żadnych działań niepożądanych związanych z laserem. Jednocześnie autor sugeruje, że w porównaniu z konwencjonalną fotokoagulacją laserową laseroterapia bezpośrednia zmiany niesie mniejsze ryzyko uszkodzenia siatkówki, ponieważ wymaga zastosowania mniejszej liczby impaktów oraz niższej całkowitej energii lasera podczas zabiegu [25]. Pozytywnie na temat bezpośredniej/nawigowanej laseroterapii w tej chorobie wypowiada się również Ramel [26].…”

Optical coherence tomogrpaphy in differential diagnosis of retinal arteriolar macroaneurysms

“…Во-вторых, диагноз диабетической ретинопатии может быть легко установлен на основании билатеральности и местной распространённости изменений глазного дна и, таким образом, исключён. В-третьих, распространённость ангиоматозных состояний значительно меньше, чем венозных окклюзий [14], и, кроме того, они обычно не имеют геморрагических осложнений.…”