Hemodynamic and structural changes in retinal arterial macroaneurysm after intravitreal anti-vascular endothelial growth factor injection
High resolution imaging with optical coherence tomography angiography and offset pinhole adaptive optics scanning light ophthalmoscope helped us visualize the hemodynamic and structural changes in a ruptured retinal arterial macroaneurysm in a 78-year-old woman. Intravitreal injection of anti-vascular endothelial growth factor was administered to ameliorate the condition.
A 78-year-old woman with a 5-day-history of decreased visual acuity (VA) in her left eye was referred to our clinic. The initial VA was 20/100. Color fundus photography showed retinal hemorrhage around the retinal arterial macroaneurysm (RAM) and optical coherence tomography (OCT) showed serous retinal detachment ( Fig. 1A, B, and F ). Optical coherence tomography angiography (OCTA) showed blood flow signal within the RAM ( Fig. 1C and G ), and the offset pinhole adaptive optics scanning light ophthalmoscope (AOSLO) video revealed pulsation and thinning of the arterial wall ( Fig. 1D-E , and [CR] ). The patient was administered intravitreal ranibizumab injection at the initial visit. One month after injection, the VA improved to 20/30, and the retinal exudative changes resolved substantially ( Fig. 2A,B, and F ). OCTA detected no indicative intra-aneurysmal flow signal ( Fig. 2C and G ), and offset pinhole AOSLO showed that the RAM was non-pulsatile and complete RAM occlusion had been achieved ( Fig. 2D-E , and [CR] ).