Takamiya Michiko
Department of Ophthalmology, Yonezawa City Hospital, Yonezawa, Japan.
Case Rep Ophthalmol. 2024 Jun 12;15(1):490-496. doi: 10.1159/000538998. eCollection 2024 Jan-Dec.
We report on one case of age-related macular degeneration and one case of diabetic macular edema with concomitant retinal arterial macroaneurysm (RAM) that were treated with anti-vascular endothelial growth factor (VEGF) intravitreal injections.
Case 1 involved a 71-year-old woman with a 30-year history of diabetes who was undergoing dialysis. Pretreatment visual acuity in the right eye was 0.4. Fundus fluorescein angiography (FA) showed that numerous microaneurysms and RAM were located at a distance of two papillary diameters from the macular area. Diabetic macular edema was diagnosed. After 12 anti-VEGF injections, the macular edema resolved, microaneurysms decreased, and the RAM also disappeared. Visual acuity in the right eye improved to 0.7. Case 2 involved an 81-year-old woman receiving treatment for disorders including hypertension and dyslipidemia. Pretreatment visual acuity in the right eye was 0.03. And vitreous hemorrhage was present. After one ranibizumab intravitreal injection, the fundus became clearly visible. Macular subretinal hemorrhage and an RAM in the upper macula area were evident on FA and optical coherence tomography. After four intravitreal injections of ranibizumab, macular hemorrhage resolved, RAM disappeared, and visual acuity improved to 0.2. All cases were treated by intravitreal injection of anti-VEGF. After several injections, the macular hemorrhage or macular edema was resolved. RAM disappeared, and visual acuity improved.
Intravitreal injection of anti-VEGF appears effective for age-related macular degeneration or diabetic macular edema with concomitant RAM. Although anti-VEGF intravitreal injections are not covered by health insurance for the treatment of RAM, their effectiveness means that the expansion of indications is desirable.
我们报告了1例年龄相关性黄斑变性和1例糖尿病性黄斑水肿合并视网膜动脉大动脉瘤（RAM）的病例，这2例患者均接受了抗血管内皮生长因子（VEGF）玻璃体腔内注射治疗。
病例1为一名71岁女性，有30年糖尿病病史，正在接受透析治疗。右眼治疗前视力为0.4。眼底荧光血管造影（FA）显示，大量微动脉瘤和RAM位于距黄斑区两个视乳头直径的距离处。诊断为糖尿病性黄斑水肿。在进行12次抗VEGF注射后，黄斑水肿消退，微动脉瘤减少，RAM也消失。右眼视力提高到0.7。病例2为一名81岁女性，正在接受包括高血压和血脂异常在内的疾病治疗。右眼治疗前视力为0.03，存在玻璃体出血。在进行1次雷珠单抗玻璃体腔内注射后，眼底变得清晰可见。FA和光学相干断层扫描显示黄斑区视网膜下出血和黄斑上区的RAM。在进行4次雷珠单抗玻璃体腔内注射后，黄斑出血消退，RAM消失，视力提高到0.2。所有病例均通过玻璃体腔内注射抗VEGF进行治疗。经过几次注射后，黄斑出血或黄斑水肿消退。RAM消失，视力提高。
玻璃体腔内注射抗VEGF似乎对年龄相关性黄斑变性或合并RAM的糖尿病性黄斑水肿有效。尽管玻璃体腔内注射抗VEGF治疗RAM不在医疗保险覆盖范围内，但其有效性意味着扩大适应证是可取的。
