First Author: S.W.Choi SOUTH KOREA
Co Author(s): K.H. Hong Y.C. Kim K.S. Kim 0 0 0 0 0 0 0 0 0
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To evaluate the efficacy of various treatment modality of macular edema(ME) and/or macular detachment associated with retinal artery macroaneurysm(RAM).
Retrospective interventional, randomized study
The study included 17 patients (17 eyes) with symptomatic RAM. All patients underwent a comprehensive ophthalmic examination, fluorescein angiography(FA), and spectral-domain optical coherence tomography(SD OCT). Ruptured and acute hemorrhagic type RAM involving macula were excluded. They were received intravitreal bevacizumab injection(IVB) in 8 eyes, focal laser photocoagulation(FLP) in 4 eyes and combined IVB and FLP in 2 eyes as a first treatment method. Three eyes were just observed due to relatively good initial visual acuity(VA) and mild ME. Each patients followed as-needed and determined further treatment. Mean best-corrected visual acuity (BCVA) and average central macular thickness (CMT) were documented and analyzed between each treatment modality. Statistical analyses were performed using SPSS software version 18.0(SPSS® Inc., Chicago, IL, USA). A P value of <.05 was considered statistically significant.
The mean follow-up period was 14.18 ± 15.3 months. The mean age was 70.24±9.35 years. Ten of 17 patients were medication for hypertension and 13 patients were women. The mean distance from fovea to aneurysm was 1.82±0.75 disc diameter(DD). The mean BCVA and CMT of all subjects at baseline were 0.54±0.41 logMAR units, 346.44±164.17 and improved at the last follow-up by 0.42±0.44 logMAR units (p=0.008), 200.07±52.62 (p=0.002). In 3 of 8 eyes, IVB-treated patients, BCVA improved and CMT decreased with initial treatment, however 5 of 8 eyes did not show any improvement even though additional treatment. They were improved after vitrectomy with 1 DD sized-sectal removal of internal limiting membrane (ILM) around RAM lesion sparing macular ILM. The mean number of injection was 1.57±0.79 and mean period to decide vitrectomy was 55.2±15.83 days after last injection. Among 4 patients treated with FLP, 2 eyes showed improvement with initial treatment, but another two eyes were improved after additional IVB. Two eyes treated with combination were improved without recurrence and 3 observed eyes showed gradual improvement over time. According to the follow-up OCT, the photoreceptor disruption patients presented a lower BCVA than that of photoreceptor preservation patients (logMAR 0.19±0.18 vs. 0.28±0.28, p=0.003).
Inravitreal bevacizumab, laser photocoagulation or combination treatment could be effective treatment option for ME and/or macular detachment secondary to RAM. In follow-up period, if ME and subretinal fluid were exacervated or slow resolution over more than 2 months even though various treatment modalities, vitrectomy with sectal removal of the ILM confined to RAM lesion should be considered for photoreceptor preservation and better visual outcome.