Koinzer Stefan, Heckmann Jan, Tode Jan, Roider Johann
Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany.
Br J Ophthalmol. 2015 Oct;99(10):1345-53. doi: 10.1136/bjophthalmol-2014-305884. Epub 2015 Apr 16.
Retinal arterial macroaneurysms (RAMAs) are acquired dilations of branches of the central retinal artery. Treatment depends on vision-limiting complications. We compare the long-term visual acuity (VA) in three groups according to treatment.
49 charts of patients with RAMA were reviewed. 16 remained untreated, 15 received photocoagulation and 18 vitrectomy. Patients underwent full ophthalmological examinations and up-to-date imaging. We evaluated chosen therapy, complications and final VA at the last visit.
65% of the cohort was female, aged 75±11 years (mean±SD). Follow-up was 34±23 months. These parameters did not differ significantly between the three groups. In the observed group, initial VA was 0.48 (mean log MAR) vs 0.35 at the final visit, in the photocoagulation group 0.55 vs 0.59, and in the vitrectomy group 1.8 vs 0.77. VA was significantly worse at enrolment in the vitrectomy group, while all other VA differences were not significant.
The overall visual prognosis of RAMA was good, even after macular complications. VA remained unchanged in the observed and the laser groups and was comparable in all groups after 3 years. Based on an individual treatment decision, all therapies were effective and efficient. If subfoveal haemorrhage caused a macular hole, the VA outcome was limited.
视网膜动脉大动脉瘤（RAMA）是视网膜中央动脉分支的后天性扩张。治疗取决于视力受限的并发症。我们根据治疗方法比较三组患者的长期视力（VA）。
回顾了49例RAMA患者的病历。16例未接受治疗，15例接受了光凝治疗，18例接受了玻璃体切除术。患者接受了全面的眼科检查和最新的影像学检查。我们评估了所选的治疗方法、并发症以及最后一次就诊时的最终视力。
该队列中65%为女性，年龄75±11岁（均值±标准差）。随访时间为34±23个月。这三个组之间的这些参数没有显著差异。在观察组中，初始视力为0.48（平均对数最小分辨角），最后一次就诊时为0.35；在光凝治疗组中，分别为0.55和0.59；在玻璃体切除组中，分别为1.8和0.77。玻璃体切除组在入组时视力明显更差，而所有其他视力差异均不显著。
即使出现黄斑并发症，RAMA的总体视力预后良好。观察组和激光治疗组的视力保持不变，3年后所有组的视力相当。基于个体化的治疗决策，所有治疗方法都是有效且高效的。如果黄斑下出血导致黄斑裂孔，视力预后有限。
