Bormann Caroline, Heichel Jens, Hammer Ute, Habermann Anke, Hammer Thomas
aAugenzentrum "Frohe Zukunft", Halle (Saale), Germany.
bDepartment of Ophthalmology, University Hospital of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Case Rep Ophthalmol. 2017 Mar 7;8(1):137-143. doi: 10.1159/000458517. eCollection 2017 Jan-Apr.
Complex retinal arterial macroaneurysms (RAM) are often accompanied by hemorrhage and/or affect the macula. We evaluated the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy using ranibizumab or aflibercept with or without laser photocoagulation in the treatment of macular edema due to RAM.
A case report of two patients with secondary macular edema caused by RAM is presented. The first case was a 76-year-old female treated with two 0.5-mg injections of ranibizumab and additional focal laser photocoagulation. This patient presented a solely intraretinal exudation. The second patient was a 96-year-old female, who received one 2.0-mg injection of aflibercept. She showed sub- and intraretinal edema. We documented the clinical courses of these patients based on fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography. Patients were followed-up for 12 months.
Patients were treated successfully using anti-VEGF therapy (ranibizumab or aflibercept) with or without laser photocoagulation. In both cases, we observed a complete regression of the macular edema and an increase in visual acuity.
RAM can manifest with heterogeneous findings. Intravitreal anti-VEGF therapy with or without laser photocoagulation may be an effective treatment option in cases of macular edema due to RAM. Aflibercept and ranibizumab seem to be a potent anti-VEGF therapy for RAM. Individualized patient care is needed.
复杂的视网膜动脉大动脉瘤（RAM）常伴有出血和/或累及黄斑。我们评估了玻璃体内注射雷珠单抗或阿柏西普联合或不联合激光光凝治疗RAM所致黄斑水肿的效果。
报告两例由RAM引起的继发性黄斑水肿患者的病例。第一例是一名76岁女性，接受了两次0.5毫克雷珠单抗注射及额外的局部激光光凝治疗。该患者仅表现为视网膜内渗出。第二例是一名96岁女性，接受了一次2.0毫克阿柏西普注射。她表现为视网膜下和视网膜内水肿。我们根据眼底照相、荧光素血管造影和光谱域光学相干断层扫描记录了这些患者的临床病程。对患者进行了12个月的随访。
使用抗VEGF治疗（雷珠单抗或阿柏西普）联合或不联合激光光凝治疗均取得成功。在两例患者中，我们均观察到黄斑水肿完全消退且视力提高。
RAM可表现出不同的症状。玻璃体内抗VEGF治疗联合或不联合激光光凝可能是治疗RAM所致黄斑水肿的有效选择。阿柏西普和雷珠单抗似乎是治疗RAM的有效抗VEGF疗法。需要对患者进行个体化护理。
