Retinal Macroaneurysm Research Articles

A Case Report on IRVAN Syndrome

Idiopathic retinal vasculitis, arteriolar macroaneurysms, and neuroretinitis (IRVAN) is a rare condition predominantly affecting young, healthy females without systemic disease. We present the case of a 35-year-old female who presented with a 3-month history of decreased visual acuity without associated symptoms. Ophthalmological examination revealed reduced visual acuity in both eyes, papillary oedema, stellate macular oedema, and haemorrhages bilaterally. Retinal imaging confirmed IRVAN syndrome. Treatment included pan-retinal photocoagulation (PRP) and intravitreal bevacizumab injections, resulting in macular oedema regression.

SERIAL CASES INTRAVITREAL TENECTEPLASE AND PNEUMATIC DISPLACEMENT OF SUBMACULAR HEMORRHAGE

Introduction : OBJECTIVE Submacular hemorrhage {SMH} is uncommon complication of choroidal or retinal vascular abnormalities, including choroidal neovascularization {CNV}, polypoidal choroidal vasculopathy {PCV} and retinal macroaneurysm of these, PCV is condition most frequency associated with large SMH {reported in 20%-63% of eyes with PCV} PURPOSE To presence successful management of submacular hemorrhage with combination injection intravitreal {IVT} Tenecteplase and gas C3F8 100%
 Case Illustration : METHODES All patient with SMH already take foto fundus and OCT pre and post IVT methalyse and gas C3F8 100%. All patients undergone IVT gas C3F8 100% 0.2 cc and take a rest for 20 second after that IVT methalyse 0.1 cc was injected. Positioning 1st 24 hours: Free Positioning, 2nd 24 hour: Positioned face down, 3rd days: Follow up.
 Discussion : RESULT The submacular hemorrhage move out from macular for all of cases. Vision improvement occourred in all cases.
 Conclusion : CONCLUTION Intravitreal Tenecteplase in conjunction with pneumatic displacement appears effective in displacing submacular blood.

PREDICTORS OF 3-MONTH AND 1-YEAR VISUAL OUTCOMES AFTER VITRECTOMY WITH SUBRETINAL TISSUE PLASMINOGEN ACTIVATOR INJECTION FOR SUBMACULAR HEMORRHAGE.

To investigate factors associated with 3-month or 1-year best-corrected visual acuity (BCVA) after vitrectomy with subretinal tissue plasminogen activator injection for submacular hemorrhage (SMH) and to identify the predictors of early displacement. This prospective cohort study included consecutive eyes with SMH complicating neovascular age-related macular degeneration or retinal macroaneurysm that underwent vitrectomy with subretinal tissue plasminogen activator injection and were followed up for at least 3 months. Parameters that correlated with 3-month BCVA, 1-year BCVA, and 2-week displacement grade (0-3) were identified. Twenty-nine eyes of 29 patients (73.1 ± 8.4 years; neovascular age-related macular degeneration, 25 eyes) were included. Logarithm of the minimum angle of resolution BCVA improved 3 months after the surgery (baseline, 0.76 [20/115] ± 0.35; 3-month, 0.51 [20/65] ± 0.32; P = 0.006). In multivariable analyses, 1-year logarithm of the minimum angle of resolution BCVA correlated with age ( P = 0.007, β = 0.39) and SMH recurrence within 1 year after surgery ( P < 0.001, β = 0.65). Two-week displacement grade correlated with the contrast-to-noise ratio of SMH ( P = 0.001, β = -0.54). Macular hole occurred in three eyes (10%) with small SMH size and was closed in all eyes via additional vitrectomy with an inverted internal limiting membrane flap technique. The recurrence of SMH negatively affected the 1-year visual outcome after vitrectomy with subretinal tissue plasminogen activator injection for SMH. The contrast-to-noise ratio was a useful predictor of early SMH displacement, but not of 1-year BCVA. Further research is necessary to determine the optimal treatment to prevent SMH recurrence.

Evaluation of a new Q-switched Nd:YAG laser on premacular hemorrhage

BackgroundPremacular hemorrhage is among the causes of sudden deterioration of visual acuity. This study aimed to investigate the therapeutic outcomes of a new Q-switched Nd:YAG laser on premacular hemorrhage.MethodsRetrospective, case series study of 16 eyes from 16 patients diagnosed with premacular hemorrhage, including 3 cases of Valsalva retinopathy, 8 cases of retinal macroaneurysm, 3 cases of diabetic retinopathy, 1 case of trauma-related hemorrhage and 1 case with leukemia. A 1064nm Q-switched Nd:YAG laser was performed to puncture the posterior hyaloid and inner limiting membrane to drain the hemorrhage.ResultsThe success rate of 16 patients with premacular hemorrhage drainage was 100% in this study. Improved visual acuity was observed in each patient.ConclusionsIn this case series of 16 patients, the new Q-switched Nd:YAG laser was successful in draining premacular hemorrhage with no serious complications.

Retinal Arterial Macroaneurysm: Report of 3 Cases

Purpose: To report a clinical analysis of three cases of Retinal Macroaneurysm with their systemic involvement. Method: An observational case series of three cases of Retinal Arterial Macroanerysm (RAM) presented at Chittagong Eye Infirmary &amp; Training Complex (CEITC). Detail history of systemic and ocular disease, thorough clinical examination, best corrected visual acuity, slit lamp biomicroscopy, indirect ophthalmoscopy, Fundus Fluorescein Angiography (FFA), Optical Coherence Tomography (OCT) scan were performed according to the cases. Diagnosis was made by ocular findings and appropriate ancillary tests. An internet search (medline search) and review of current literature on Retinal Arterial Macroanerysm were done and information relevant to our objectives was obtained. Result: Three patients presented with blurring of vision in affected eye. All of them were female &amp; at or above sixty years of age. Three affected eyes of three patients were analyzed. Vision on presentation 6/60 or worse in affected eyes in all cases. Their anterior segment showed no abnormality. Fundus showed more than one RAM along upper temporal arcade of left eye in 1st patient, 2nd patient showed single RAM at macula along upper temporal arcade of right eye, 3rd one showed a round RAM surrounded with haemorrhage &amp; exudates on macula along lower temporal arcade of right eye . Fundus fluorescin angiogram (FFA) revealed in all three patients hyper &amp; hypo fluorescein at macular and surrounding area due to RAM and associated intra retinal haemorrhage and exudates. Opitcal Coherance Tomograhy (OCT) done in first 2 cases after laser therapy showed normal foveal thickening. Second case gets intravitreal injection avastin in addition to laser. After laser treatment first case showed visual improvement from counting finger ( CF) to 6/12, third case also showed improvement from 6/60 to 6/9 though short follow up, but second case showed visual deterioration fron 6/60 to counting finger with all the treatment. Conclusion: Though Retinal Macro anerysm is a rare disease but it can cause loss of vision due to foveal involvement. Proper and in time intervention may rescue the vision.

Management and prognosis of vitreous haemorrhage

AbstractVitreous haemorrhage is one of the most common causes of sudden deterioration in vision with an incidence of seven cases per 100 000 and it is affecting most often only one eye.The most common causes for nontraumatic, spontaneous vitreous haemorrhage include diabetic retinopathy, retinal tear/detachment, vitreoretinal traction resulting from posterior vitreous detachment, retinal venous occlusive disease, ruptured retinal macroaneurysm, and exudative age‐related macular degeneration In the setting of severe vitreous haemorrhage and no visualization of the fundus and without a history of underlying cause the diagnosis may be challenging. B‐scan is the most useful diagnostic tool but ultrasound has limitations both in sensitivity and specificity for excluding retinal tear and detachment, as well as operator dependent variability. General ophthalmologists tend to follow up patients, waiting the haemorrhage to clear or to have some indication for the underlying pathology. This waiting time could compromise the final visual outcome of a vitreous haemorrhage related to retinal breaks or affect the quality of life of patients. With the safety profile of modern small gauge vitreoretinal surgery we would suggest an early referral of all cases to vitreoretinal surgeons as delayed diagnosis and management could implicate consequences affecting the final visual result.

Complicated Arterial Retinal Macroaneurysm

Retinal macroaneurysm.is a rare complication of uncontrolled IHT. It is responsible for exudative phenomena with DSR which can threaten visual function especially if it is macular localization. The prognosis depends on 'the importance of exudation and alteration of photoreceptors. Treatment remains essentially physical.

Differences in clinical characteristics and treatment outcomes of submacular hemorrhage caused by age-related macular degeneration and retinal macroaneurysms: A multicenter survey from the Japan Clinical Retina Study (J-CREST) group.

PurposeTo evaluate the clinical characteristics, treatment trends, and visual prognosis of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD) and retinal arterial macroaneurysm (RAM).MethodsThis retrospective study enrolled 187 Japanese patients with SMH at 10 institutions from 2015 to 2018. Medical records including SMH etiology, best-corrected visual acuity (BCVA), fundus photographs, optical coherence tomography images, and selected treatments were analyzed.ResultsMajor causes of SMH were typical nAMD (tnAMD) (18%), polypoidal choroidal vasculopathy (PCV) (50%) and RAM (29%). Age, male/female ratio, baseline BCVA, central retinal thickness, and involved retinal layers were significantly different between etiologies (all P<0.0001). Treatment with anti-vascular endothelial growth factor drugs with and without intravitreal gas injection was chosen for half of eyes in the tnAMD and PCV groups, whereas vitrectomy was performed in 83.7% of eyes with RAM. The final BCVA improved significantly from baseline in the PCV and RAM groups (P = 0.0009, P<0.0001) and final BCVA was significantly better in the PCV group at a level similar to the other groups (P = 0.0007, P = 0.0008). BCVA improvement from baseline was significantly greater in the RAM group compared with the tnAMD (P = 0.0152) and PCV (P = 0.017) groups. Multivariate analysis revealed better final BCVA was significantly associated with younger age (P = 0.0054), better baseline BCVA (P = 0.0021), RAM subtype (P = 0.0446), and no tnAMD (P = 0.001).ConclusionsThe characteristics of, and treatment strategy for, SMH were different between the underlying diseases. Anti-vascular endothelial growth factor treatment with or without expansile gas was mainly chosen for SMH in tnAMD and PCV, whereas vitrectomy with gas was the most common treatment for RAM, and the higher rate for vitrectomy might result in the greater BCVA improvement in the RAM group than in the other groups. Final BCVA was better in PCV, RAM, and tnAMD, in that order, because patients with PCV were younger and had better baseline BCVA.

IRVAN syndrome: A retrospective review of 9 cases from Tunisia

To describe clinical features, relevant imaging findings, disease course, and response to treatment in 9 patients (18 eyes) with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Retrospective review of the charts of nine patients (18 eyes) diagnosed with IRVAN syndrome at Fattouma Bourguiba University Hospital, Monastir, Tunisia, from January 1, 2011 to January 1, 2022. Nine patients were included with bilateral involvement in all cases. Mean initial best-corrected visual acuity (VA) was 20/32 (range, 20/1600-20/20). Clinical findings at presentation included vitreous cells (10 eyes, 55.6%), peripapillary exudates (12 eyes, 66.7%), partial or complete macular star (11 eyes, 61.1%), and vascular sheathing (11 eyes, 61.1%). Fluorescein angiography showed arteriolar aneurysms (18 eyes, 100%), areas of peripheral capillary non-perfusion (16 eyes, 88.9%), and retinal neovascularization (6 eyes, 33.3%). Optical coherence tomography showed macular edema in 5 eyes (27.8%). Optical coherence tomography angiography of the optic disc demonstrated papillary aneurysms in 4 eyes of 2 patients. Indocyanine green angiography showed retinal arteriolar aneurysmal dilatations in 4 eyes of 2 patients. Ten eyes (55.6%) had stage 2 disease, 6 eyes (33.3%) had stage 3, and 2 eyes (11.1%) had stage 1. Treatment modalities included peripheral photocoagulation (16 eyes, 88.9%), intravitreal bevacizumab (4 eyes, 22.2%), and intravitreal triamcinolone acetonide (1 eye, 5.6%). Mean final best-corrected VA was 20/32 (range, 20/600-20/20). Ocular complications included vitreous hemorrhage in 3 eyes (16.7%), branch retinal artery occlusion in 2 eyes (11.1%) and submacular fibrosis in 3 eyes (16.7%). IRVAN syndrome should be highly suspected in patients with peripapillary exudates associated with vascular sheathing and vitreous cells. Multimodal imaging confirms the diagnosis by showing retinal macroaneurysms. Early treatment of macular edema and/or peripheral retinal non-perfusion is mandatory to improve prognosis.

Effect of combined laser and anti-vascular endothelial growth factor in a retinal capillary macroaneurysm.

Effect of combined laser and anti-vascular endothelial growth factor in a retinal capillary macroaneurysm.

Branch retinal artery occlusion as a complication of retinal macroaneurysm

Branch retinal artery occlusion as a complication of retinal macroaneurysm

Intravitreal ranizumab in exudative symptomatic retinal arterial macroaneurysms

AbstractPurposeTo assess the anatomical and functional results in exudative symptomatic retinal arterial macroaneurysms (RAM) treated with anti‐VEGF.MethodObservational retrospective study including 10 patients with 10 eyes with diagnosis of exudative symptomatic retinal arterial macroaneurysm. Given that the RAMs were located within the superior and inferior temporal arcades, they were treated with intravitreal ranizumab (Lucentis ®). Patients received a loading dose of 3 monthly injections of ranibizumab (0.5 mg/0.05 ml) followed by an additional injection if necessary. Best corrected visual acuity (BCVA) and central macular thickness (CMT) was assessed both prior to the treatment as well as posteriorly in the follow‐up visits.Results10 patients were included, of whom 5 were men and 5 were women. The average age was 72.9 years. The average follow‐up period was 7.9 ± 2 months, during which there was a remarkable visual and anatomical recovery (all patients improved their BCVA 3 or more Snellen lines). BCVA improved significantly compared to baseline BCVA from 0.21 ± 0.2 to 0.6 ± 0.28. The average decrease after treatment in CMT measured with OCT was also significant, decreasing from 590.2 ± 163.8 μm previous to treatment to 291.6 ± 61.4 μm after treatment. No complications were observed with the intravitreal injection of ranizumab.ConclusionInjections of anti‐vascular endothelial growth factor may be a therapeutic option in cases of symptomatic exudative RAM. Other types of studies are needed to recommend this treatment in this entity.Bibliography Russell SR, Folk JC. Branch retinal artery occlusion after dye yellow photocoagulation of an arterial macroaneurysm. Am J Ophthalmol 1987; 104:186–187. Wenkstern AR, Petersen H. Intravitreal ranibizumab in retinal macroaneurysm. Graefes Arch Clin Exp Ophthalmol 2010; 248:1667–1670. Zweifel SA, Tönz MS, Pfenninger L, et al. Intravitreal anti‐ VEGF therapy for retinal macroaneurysm. Klin Monbl Augen‐ heilkd 2013; 230:392–395. Erol MK, Dogan B, Coban DT, et al. Intravitreal ranibizumab therapy for retinal arterial macroaneurysm. Int J Clin Exp Med 2015; 8:11572–11578. Chatziralli I, Maniatea A, Koubouni K, et al. Intravitreal ranibizumab for retinal arterial macroaneurysm: long‐term results of a prospective study. Eur J Ophthalmol 2017; 27:215–219.

Multiple Retinal Macroaneurysms in a Hypertensive Patient

Purpose: The evaluation of different therapeutic strategies in a patient with multiple retinal arterial macroaneurysms. Case: A 71-year-old female hypertensive patient is treated for several retinal macroaneurysms both exudative and hemorrhagic, over a period of four years. Clinical evaluation, fluorescein angiography and optical coherence tomography findings are included. Results: Hypertension is strongly associated with macroaneurysm development. Indirect laser treatment and vitrectomy are proven useful when indicated according to the type of the lesion and the visual outcome is encouraging even after several interventions. Conclusion: Although acquired RAMs are usually considered solitary lesions, a patient with four RAMs in the same eye is described in the present report. The characteristics of each RAM require a different therapeutic strategy and close monitoring is also essential.

Visual Outcome after Vitrectomy with Subretinal tPA Injection to Treat Submacular Hemorrhage Secondary to Age-Related Macular Degeneration or Macroaneurysm.

Purpose To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy, subretinal injection of tissue plasminogen activator using the EVA Surgical System, and pneumatic displacement with air to treat submacular hemorrhages. Methods Retrospective analysis of 93 eyes surgically treated for submacular hemorrhage caused by neovascular AMD or retinal macroaneurysms. Main Outcome Measures. Postoperative visual acuity and surgical complications. Results After surgery, visual acuity improved after 6 weeks but decreased again at the final postoperative visit at 8 months due to progression of the underlying disease. Complications consisted of 2 cases of retinal pigment epithelial tear, 7 vitreous hemorrhages, 4 hyphema, 6 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period. Conclusions This study suggests that a surgical approach with 23G vitrectomy, subretinal tPA injection, and pneumatic displacement using air may be an effective procedure for submacular hemorrhage displacement in patients with AMD and retinal macroaneurysms. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.

Retinal racemose hemangioma and macroaneurysm with multilayered hemorrhage

A 42-year-old female presented with sudden diminution of vision in the right eye (RE) for 1 day. The vision was counting fingers with Relative afferent pupillary defect (RAPD) (RE) and 20/20 (LE). Fundus revealed dilated tortuous arteries and veins in all quadrants with premacular and submacular hemorrhage. Fundus fluorescein angiography (FFA) showed nonleaking vascular loops with hypofluorescence at the macula. Optical coherence tomography (OCT) revealed localized posterior hyaloid detachment with hemorrhage. We report this unilateral case of retinal racemose hemangioma with multilayered hemorrhage managed with pneumatic displacement and revealed retinal artery macroaneurysm in the background. On follow-up there was development of localized vitreomacular traction. It was treated with Yttrium Aluminium Garnet (YAG) hyaloidotomy, which improved vision to 20/80.

Unilateral Retinal Arteritis and Macroaneurysm in Sarcoidosis

ABSTRACT Background Sarcoidosis, an idiopathic systemic disorder characterized by noncaseating granulomas, is often associated with granulomatous uveitis. Anterior segment involvement can present with mutton-fat keratic precipitates, anterior chamber cell, and iris nodules. Sarcoid associated posterior uveitis may present with vitritis, retinal vasculitis, and choroidal lesions. Case summary Sarcoid-associated retinal vasculitis is classically thought of as predominantly involving veins, but in this case report we describe a 76-year-old Caucasian woman presenting with bilateral posterior uveitis, unilateral optic nerve head granuloma, and retinal arteritis as the first manifestation of ocular involvement in systemic sarcoidosis. Conclusion This case describes the uncommon first manifestation of ocular involvement in systemic sarcoidosis presenting with unilateral retinal arteritis, macroaneurysms and optic nerve head granuloma.

Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms

Purpose: To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms.Methods: We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups.Results: The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p &lt; 0.001).Conclusions: Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.

Макроаневризма сосуда сетчатки после каротидной эндартерэктомии у пациента с хронической ишемической ретинопатией, ассоциированной с гемодинамически значимым стенозом внутренней сонной артерии (клинический случай)

Purpose. To present a clinical case of development of retinal macroaneurysm after carotid endarterectomy (CE) in patient with chronic ischemic retinopathy (CIR) associated with hemodynamically significant stenosis of the internal carotid artery (ICA). Material and methods. Patient R., 74 years old, diagnosed with CIR of the 1st degree of severity of the right eye. In addition to standard ophthalmic examination methods, Doppler ultrasound with registration of blood flow in the orbital artery and spiral computed tomography of the ICA were performed. Results. Panretinal photocoagulation (PRP) of the retina led to obliteration of the retinal macroaneurysm, resorption of intraretinal hemorrhages, and stabilization of the course of CIR after CE of the ICA. Conclusion. The appearance of retinal macroaneurysm and intraretinal hemorrhages after CE in patient with CIR associated with hemodynamically significant ICA stenosis can be regarded as reperfusion complications after restoration of blood flow in the orbital artery, which requires timely retinal PRP of the retina. Key words: chronic ischemic retinopathy, retinal macroaneurysm, internal carotid artery, carotid endarterectomy.

Ruptured retinal macroaneurysm: A case report

Retinal arterial macroaneurysms are acquired, focal dilations of retinal arterial branches. It usually occurs in the first three orders of the arterial tree. It can present as insidious loss of central vision following leakage which involves the macula or less commonly it could cause sudden loss of vision following haemorrhage. The variable clinical presentation could make diagnosis difficult with a wide range of differentials

Recombinant Tissue Plasminogen Activator (rtPA) in the Treatment of Macular Hemorrhages

Macular hemorrhage is a frequent complication of retinal macroaneurysms and represents a threat to central vision. We report the surgical use of recombinant tissue plasminogen activator (rtPA) in the treatment of macular hemorrhage. Two eyes of 2 female patients with macular hemorrhage from ruptured retinal macroaneurysms were treated with subretinal rtPA injection. Visual acuities on admission were of counting fingers (<20/400) in the 2 eyes treated. Best corrected visual acuity improved to 20/100. No major intraoperative complications were reported. Macular hemorrhage presents a low rate of spontaneous resolution and, left untreated, portends a poor prognosis. Subretinal injection of rtPA is a challenging, yet effective surgical technique, with rates of hemorrhage displacement reported between 50%-90%.