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S. Yzer, J. P. Martinez Ciriano, L. I. van den Born, G. S. Baarsma, M. Veckeneer, T. Missotten; Foveal and Extra-Foveal Symptomatic Retinal Arterial Macroaneurysms: Therapeutic Options and Outcome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3538.
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There is no consensus on treatment of symptomatic retinal arterial macroaneurysms (SRAM). We evaluated the outcome of different therapeutic approaches.
Thirty-five patients with SRAM were studied retrospectively. All patients visited our clinic with SRAM between 2006 and 2009. They underwent complete ophthalmic examination, including Snellen best corrected visual acuity (BCVA), fluorescein angiography and OCT. Treatment was only initiated in SRAM patients with macular edema or submacular hemorrhage. Photocoagulation by green laser was used to in case of leakage with macular edema. A pars plana vitrectomie (PPV) with recombinant tissue-plasminogen activator (rt-PA) was performed for submacular hemorrhage.
Thirty-five eyes in 30 women and 5 men with an average age of 80 years (55-96 years) were studied. Twenty patients presented with SRAM in the posterior pole outside of the fovea (12 superior, 8 inferior). Fifteen patients had SRAM within 2 disc diameters of the centre of the fovea. In 11 patients no treatment was initiated, 20 patients underwent laser, and 4 PPV with rt-PA. In the extra foveal SRAM group, mean BCVA changed from 0.41 (hand movements to 0.9) to 0.63 after treatment. In the foveal SRAM group, BCVA changed from 0.19 to 0.24 post treatment. The BCVA in patients who received rt-PA before treatment was 0.24 and after treatment 0.22. In patients who underwent laser the BCVA before treatment was 0.27 and after ARLA laser 0.53. In patients who did not receive treatment BCVA at time of symptoms was 0.45 and after follow-up 0.43.
SRAM is predominantly found in women in the superior extra-foveal area. Macular edema caused by SRAM responds well to treatment with photocoagulation. Visual prognosis of SRAM associated with submacular hemorrhage is definitely worse. Subretinal rt-PA injection seems to preserve vision in these patients.
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