Hemodynamic and structural changes in retinal arterial macroaneurysm after intravitreal anti-vascular endothelial growth factor injection





Abstract


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.


1


Case report


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. 1 A, B, and F ). Optical coherence tomography angiography (OCTA) showed blood flow signal within the RAM ( Fig. 1 C and G ), and the offset pinhole adaptive optics scanning light ophthalmoscope (AOSLO) video revealed pulsation and thinning of the arterial wall ( Fig. 1 D-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. 2 A,B, and F ). OCTA detected no indicative intra-aneurysmal flow signal ( Fig. 2 C and G ), and offset pinhole AOSLO showed that the RAM was non-pulsatile and complete RAM occlusion had been achieved ( Fig. 2 D-E , and [CR] ).




Fig. 1


A ruptured retinal arterial macroaneurysm (RAM) was detected in the left eye of a 78-year-old-female. Color fundus photography and optical coherence tomography (OCT) show retinal and subretinal hemorrhage and serous retinal detachment around the RAM ( A, B, and F ) (arrow indicates the RAM in OCT). OCT (OCT-A1, Canon) shows blood flow signal within the RAM lesion ( C and G ). Offset pinhole adaptive optics scanning light ophthalmoscope shows pulsation and extreme thinning of the affected arterial wall with high resolution ( D-E , and [CR] ). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)



Fig. 2


Findings of the retinal arterial macroaneurysm (RAM) one month after intravitreal ranibizumab injection. Color fundus photography shows substantial regression of the retinal exudative changes ( A ) and the RAM appears greyish-white and smaller ( B ). Optical coherence tomography (OCT) shows complete resolution of the retinal hemorrhage and serous retinal detachment ( F ) (arrow indicates the RAM in OCT). Optical coherence tomography angiography shows the absence of blood flow signal in the RAM lesion ( C and G ). Offset pinhole adaptive optics scanning light ophthalmoscope video shows non-pulsative RAM lesion, suggesting organization of the affected arterial wall ( D-E , and [CR] ). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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Jan 3, 2022 | Posted by in OPHTHALMOLOGY | Comments Off on Hemodynamic and structural changes in retinal arterial macroaneurysm after intravitreal anti-vascular endothelial growth factor injection

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