Effect of combined laser and anti-vascular endothelial growth factor in a retinal capillary macroaneurysm.

Retinal capillary macroaneurysms (RCMAs) are derived from capillaries and are typically smaller than retinal arterial macroaneurysms (RAMs), which arise from muscular arterioles. Spaide et al.[1] described them as large, solitary, and persistent, with incomplete response to anti-vascular endothelial growth factor (VEGF) injections but showing regression with laser photocoagulation.

A 58-year-old male with bilateral cortical cataract and diabetic retinopathy (DR) was referred for further management. On examination, the best-corrected visual acuity (BCVA) in the right eye [oculus dextrus (OD)] was counting fingers at 50 cm,

Figure 1

Left eye fundus photograph (Daytona OptosAdvance) at presentation of a 58-year-old male patient showing PDR changes, centre involving DME, hard exudate plaques and large juxta-foveal aneurysm with surrounding intraretinal fluid

Optical coherence tomography (Zeiss PLEX Elite 9000) revealed a spheroid lesion in the inner retinal layers with a hyper-reflective wall and hypo-reflective lumen suggestive of RCMA [Fig. 2a]. Pan retinal photocoagulation was done for PDR. The patient underwent two monthly injections of Ranibizumab [Fig. 2b], followed by yellow 577 nm ophthalmic laser (IRIDEX IQ577) to the RCMA with 100 mW power, 100 ms duration and 100-micron spot size, [Fig. 2c] and three subsequent monthly injections of ranibizumab. At the last follow-up, BCVA was 6/36, N12 in OS with involution of the RCMA and absence of intraretinal fluid [Fig. 2d].

Figure 2

Sequential Enface and B scan optical coherence tomography (Zeiss PLEX Elite 9000) images of a 58-year-old male showing changes in RCMA (asterisk) corresponding to interventions adopted. (a) At initial presentation, (b) post two monthly injections of Ranibizumab, (c) six months post yellow laser and (d) post three subsequent monthly injections of Ranibizumab

Discussion

DR-related macroaneurysm was first described by Bourhis et al.[2] as ‘telangiectatic capillaries’. Their prevalence and incidence, however, still remain unknown in DR. These are likely to be seen in areas close to the hard exudates.[3] Although there are no reports of involution of RCMA by combined treatment strategies, there are anecdotes for RAM showing effective outcomes.[45] Our case shows that a combined treatment strategy could be considered for RCMAs in DME.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.