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Jacob Meyer, Gaurav Shah; Retrospective analysis of laser therapy versus observation for symptomatic retinal artery macroaneurysms. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5771.
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To compare the long-term clinical course of patients with symptomatic retinal arterial macroaneurysms (RAMs) treated with laser photocoagulation versus patients which were observed without treatment.
Patients charts with documented RAMs diagnosed between 2003 and 2012 were reviewed. Patients with symptomatic lesions and at least 6 months of follow up were included in the study. Patients who underwent vitrectomy for vitreous or submacular hemorrhage, or that received injections of anti-VEGF or steroid therapy were excluded. 13 eyes treated by direct laser photocoagulation and 14 eyes that were observed without treatment were included in the study. Visual acuity (VA) data were converted to logMAR scores for statistical analysis.
The two study groups had similar demographic characteristics. Average follow up time was 24 months in the treated group and 18 months in the observed group. 6 of the 13 patients treated with laser required a second treatment. Initial logMAR VA was similar in the two groups (1.14 in the treatment group and 1.11 in the observation group). The treatment group improved to a final VA of 0.51 while the observation group improved to 0.77 at final follow up. All patients showed resolution or near resolution of hemorrhage and macular edema at final visit. 3 patients in the observed group had a final VA of worse than 20/200, all due to submacular scar formation. No patients in the treated group had a final VA worse than 20/200.
The natural history of RAM lesions shows gradual improvement of clinical signs and visual acuity over time without treatment. However, treatment with direct laser photocoagulation seems to be associated with greater improvement in VA and may decrease the chance of permanent severe visual loss.
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