Laser and Anti–Vascular Endothelial Growth Factor Agent Treatments for Retinal Arterial Macroaneurysm

Abstract

Focal laser photocoagulation was helpful for the management of ruptured or leaky RAM. Combined focal laser and intravitreal anti-VEGF agents could better reduce macular exudation caused by RAM. Additionally, Nd:YAG laser was a safe and effective method to remove the sub-ILM hemorrhage caused by RAM.

Swept source optical coherence tomography angiography of a case of retinal artery macro-aneurysm before and after combined laser and intra-vitreal ranibizumab treatment

“…Intra-vitreal anti-vascular endothelial growth factor (anti-VEGF) injections have emerged as a useful treatment modality in patients with retinal artery macroaneurysms (RAMs). [ 1 ] There are a few case reports suggesting that the combined use of focal laser and anti-VEGF agents could better reduce macular exudation caused by RAM,[ 2 ] and Lewis et al . have also reported that direct laser of the RAM lesion and the surrounding area of exudation may decrease the flow and intra-luminal pressure.…”

Comment on: Outcomes of combined treatments in patients with retinal arterial macroaneurysm

“…[ 2 ] Their behaviors toward IVR and FLP (if the view still allows) are different. [ 3 ] How was the distribution of these two in the case series? Lipid exudates deposited over the fovea would affect visual acuity despite subsequently dried-up retina; we are interested in how many cases got an exudate (e.g., patient 3) on top of the serous retinal detachment listed out in Table 1.…”

Outcomes of combined treatments in patients with retinal arterial macroaneurysm

“…[ 5 6 7 ] Focal laser photocoagulation (FLP) has been used in the treatment of RAMs for many years, which can be performed directly to the body of RAMs for promoting involution or decreasing leakage, or indirectly to the adjacent area around the RAMs for stopping or decreasing the progression of leakage toward the macula. [ 8 9 10 11 12 13 14 ] Currently, there is no defined criterion for when and how this treatment should be used. Many complications can occur after the FLP treatment, including large scar, choroidal neovascularization, and subretinal fibrosis.…”

“…To reduce the side effect and the need for repeated applications, intravitreal ranibizumab (IVR) injection has been used in combination with FLP in treating many fundus diseases that have abnormal tissue growth and/or edema. [ 8 16 24 25 26 27 28 29 30 31 ] The two methods appear to be complementary in that IVR can shrink the new growth and reduce the edema so that the FLP can reach the therapeutic effect with a lower dose; while the FLP would help to maintain a long treatment effect so that repeated IVR injects will not be necessary. Therefore, the combination of the two methods appears to produce a better treatment effect and few side effects than each of the two methods applied alone.…”

“…[ 25 27 28 29 ] In a recent report, such a combination was used in the treatment of RAMs. [ 8 ] In this report, however, FLP was applied prior to the anti-VEGF treatment. The logic underneath this sequence is not clear.…”