Original article
Intravitreal Bevacizumab for Symptomatic Retinal Arterial Macroaneurysm

https://doi.org/10.1016/j.ajo.2012.12.003Get rights and content

Purpose

To evaluate the therapeutic effect of intravitreal bevacizumab injection for symptomatic retinal arterial macroaneurysm.

Design

Retrospective interventional case series.

Methods

The study included 23 patients (23 eyes) with symptomatic retinal arterial macroaneurysm. They were categorized according to treatment method into 2 groups: an intravitreal bevacizumab–treated group (11 eyes) and an untreated group (12 eyes). Bevacizumab was injected at the initial visit, followed by as-needed monthly reinjection. Best-corrected visual acuity (BCVA) and central macular thickness were documented and analyzed between groups.

Results

The mean follow-up period for all subjects was 10.83 ± 4.6 months. The mean number of injections for the treated group was 1.42 ± 0.69. The mean logarithm of the minimal angle of resolution (logMAR) of BCVA improved from baseline at the last follow-up by 0.26 in the bevacizumab-treated group (P = .02) and by 0.34 in the untreated group (P = .005). Average central macular thickness decreased from 384.4 ± 150.1 μm to 265 ± 112.5 μm in the bevacizumab-treated group (P = .0002) and from 413.2 ± 155.2 μm to 236.3 ± 103.5 μm in the untreated group (P = .008). The BCVA was significantly improved from baseline after 1 month in the bevacizumab-treated group (P = .02) and after 3 months in the untreated group (P = .01). However, there was no statistically significant difference in BCVA improvement or central macular thickness improvement achieved at the final visit.

Conclusions

Intravitreal bevacizumab injection likely hastens resolution of macular edema and hemorrhage secondary to retinal arterial macroaneurysm. Intravitreal bevacizumab injection could be an effective treatment option for symptomatic retinal arterial macroaneurysm.

Section snippets

Methods

We retrospectively reviewed the medical records of 58 consecutive patients with retinal arterial macroaneurysm who were treated at the Retina Center of Kim's Eye Hospital in Konyang University College of Medicine from June 2008 through February 2012. This study was approved by the Institutional Review Board of Kim's Eye Hospital, Konyang University College of Medicine. Clinical research in this study followed the tenets of the Declaration of Helsinki.

Results

Out of the 58 patient records examined, 23 eyes (23 patients) were included in analysis and 35 eyes (35 patients) were excluded from analysis. Eleven eyes had no macular hemorrhage or exudates, 12 required vitrectomy because of a thick vitreous hemorrhage, and 12 were treated using laser photocoagulation or a combination of intravitreal anti-VEGF and laser photocoagulation. Table 1 summarizes patient characteristics and their treatment results. The mean age of the subjects was 70.3 ± 9.5 years

Discussion

The best approach to the management of retinal arterial macroaneurysm is still a matter of controversy. Spontaneous obliteration of aneurysm with functional recovery is well known.1, 2, 3, 4 However, the long-term persistence of exudative manifestations or hemorrhages leads to a progressive photoreceptor deterioration with functional impairment.5 Thus, in cases of symptomatic retinal arterial macroaneurysm with exudative or hemorrhagic changes involving the fovea together with visual acuity

Han Joo Cho, MD, graduated from the Yonsei University College of Medicine, Seoul, Korea in 2001. In 2006, he completed his residency at the Department of Ophthalmology of the same university. After a fellowship at the Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea, he has been a vitreoretinal surgeon at the same hospital since 2010. His primary areas of interest are vitreoretinal disorders and vitreous surgery.

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