Intravitreal Anti-VEGF Injections for Exudative Retinal Arterial Macroaneurysms: Results of an International Multicenter Study

Abstract

Purpose : There is no established therapy for exudative-hemorrhagic complications in primary retinal arteriolar macroaneurysm (RAM). The aim of the study is to further delineate the risks and benefits of anti-VEGF therapy in eyes with RAM and visual loss.

Methods : Retrospective multicenter interventional study of anti-vascular endothelial growth factor (anti-VEGF) in symptomatic RAM. Central macular thickness (CMT) in microns and best corrected visual acuity (BCVA) in logMar were correlated with RAM size and distance to the macula. Statistical analyses were performed using paired comparisons and Pearson correlation.

Results : 32 eyes (32 patients) were treated with a mean of 2.7 injections over mean follow-up of 16.6 months. Initial BCVA correlated with RAM size and distance to the macula (p=0.02). Ranibizumab was used in 14 patients, bevacizumab in 16 patients, and aflibercept in 2 patients (in combination with bevacizumab in 1 patient, and with both ranibizumab and bevacizumab in 1 patient). CMT decreased by 131,180, 211 at 1, 2, 3 months after the first injection (p<0.001). BCVA improved by 0.47 and 0.38 at 2 and 3 months (p=0.005). Anti-VEGF response correlated with RAM size (p=0.04) and distance to the macula (p=0.009). No eye had retinal bleeding or re-bleeding while under anti-VEGF therapy. Most RAM closed (functional closure in 31 of 32 eyes) after a few injections.

Conclusions : Symptomatic RAM can be treated successfully with anti-VEGF injections leading to decrease in macular edema.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.