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Benedicte Marie Dupas, Elise Philippakis, serge meimon, Clémence Bonnet, Jean-Francois GIRMENS, Michel Paques; Indocyanine green-guided targeted photocoagulation of macroaneurysms in macular edema: a pilot study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3246.
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© ARVO (1962-2015); The Authors (2016-present)
In longstanding diabetic macular edema (DME) or retinal vein occlusion (RVO), large vascular abnormalities may cause macular edema. Indocyanine green angiography (ICGA) has been shown to optimize their detection (Bouhris et al. 2010). Here we report the anatomical and functional outcome of the elective photocoagulation of large microvascular abnormalities, termed here macroaneurysms.
Retrospective, interventional, two-center study. In patients with chronic macular edema with severe hard exsudates due to diabetic retinopathy or to RVO, the presence of macroaneurysms (defined by a diameter larger than 150µm) was assessed by ICGA and optical coherence tomography (OCT). Macroaneurysms were selectively photocoagulated. Immediate photothrombosis was assessed by post-operative OCT.
Four eyes from 3 patients with DME and 5 eyes from 5 patients with RVO were included. The median duration of visual loss was 4 years. Median initial visual acuity (VA) was 20/200. The median number of macroaneurysms per eye was 2 (range, 1-8) and their mean size was 484µm (range, 154-1800). Six months after photocoagulation, there was a significant reduction of macular thickness (mean± SD, 528µm ± 200 versus 271µm ±152, p<0.05) and improvement of VA (mean logMAR, 0.82 versus 0.58, p<0.05).
During macular edema with severe hard exsudates due to DME or RVO, systematic detection of macroaneurysms by ICGA followed by their OCT-controlled photocoagulation may be very useful. These results may contribute to reevaluate the role of photocoagulation in the management of longstanding macular edema.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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