Combined approach in the treatment of multiple retinal arterial macroaneurysms

Retinal arterial macroaneurysm (RAM) is characterised as a saccular or fusiform dilation of retinal arterioles of the first to third order. The main diagnostic methods for RAM include ophthalmoscopy, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A). Currently, there is no established guideline for patients with RAM. There are limited number of RAM cases in available literature, which may be related to the rarity of this condition in the population. However, the following treatment options have been mentioned: focal laser photocoagulation, micropulse laser therapy, and intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors. A 58-year-old female patient with RAM complicated by macular edema with a central retinal thickness (CRT) of 398 μm underwent staged combined laser-surgical treatment. At the first step, intravitreal anti-VEGF therapy was performed. Reduction of retinal thickness allowed to progress to the second step – focal laser photocoagulation along the affected vascular arcade. Best corrected visual acuity (BCVA), central retinal sensitivity, and CRT were evaluated. After the combined treatment was carried out, BCVA improved from 0.8 to 1.0. OCT showed a decrease in CRT to 262 μm (Δ136 μm). Microperimetry demonstrated an increase in central retinal sensitivity from 25.8 dB to 27.6 dB. This clinical case demonstrates that a combined approach to treatment including intravitreal anti-angiogenic therapy followed by focal laser photocoagulation is effective in the resorption macular edema height and improving visual function.