Treatment of macular edema caused by leber's miliary aneurysms using intravitreal aflibercept and peripheral laser photocoagulation

Abstract

Purpose: This study aims to determine if intravitreal aflibercept (IVA) is effective in the treatment of macular edema (ME) caused by Leber's miliary aneurysm (LMA), augmented with peripheral laser photocoagulation for the abnormal vessels. Subjects and Methods: This prospective interventional noncomparative case series included 6 eyes of 6 patients with a clinical diagnosis of LMA, based on fluorescein angiography and optical coherence tomography (OCT) findings. Laser photocoagulation was performed to the aneurysms, except those near the fovea. Three to five IVA injections were needed to dry off the macula. Serial color fundus photography and OCT were performed to measure treatment efficacy. Results: After 3–5 IVA, the ME responded marvelously in all patients. One patient had recurrent ME 3 months later, for which an additional 2 IVA was needed. Again one session of ablative laser for diseased vessels was enough for all except for one patient who needed supplemental laser therapy 4 months later. Improved visual acuity was noted in all cases without reported ocular or systemic complications. Conclusion: IVA with peripheral laser ablation appears to be an effective treatment for patients with LMA, as it has the potential to improve final visual acuity.