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Case Reports
. 2015 Jun 2;6(2):170-5.
doi: 10.1159/000431353. eCollection 2015 May-Aug.

Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab

Carlos Menezes  1 , Rui Carvalho  1 , Carla Teixeira  1 , José Alberto Lemos  1 , Rita Gonçalves  1 , Pedro Coelho  1 , André Lima  1
Affiliations
Case Reports

Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab

Carlos Menezes et al. Case Rep Ophthalmol. .

Abstract

Purpose: We report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab.

Methods: We report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented.

Results: His best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment.

Conclusions: Intravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.

Keywords: Exudative retinal macroaneurysm; Fovea; Intravitreal ranibizumab.

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Figures

Fig. 1
Fig. 1
a, b Fundus retinography showing bilateral mild retinopathy (microaneurysms) and a retinal macroaneurysm in the nasal fovea of the OS with macular edema and surrounding hard exudates. c, d FA of the OS showing homogenous and almost a total filling of the macroaneurysm in the middle phase and late diffusion. e OCT (Copernicus S-OCT) of the OS showing the macroaneurysm as a structure with a hypereflective wall and a hyporeflective lumen, lying in the inner retina around 400 μm nasally to the foveal center and surrounded by cystoid macular edema, hard exudates and a foveal neurosensory detachment.
Fig. 2
Fig. 2
a A middle-phase angiogram of the OS after the 3rd injection of intravitreal ranibizumab showing an irregular and incomplete filling of the macroaneurysm and less diffusion. b OCT (Copernicus S-OCT) of the OS after the 3rd injection of intravitreal ranibizumab showing an almost complete occlusion of the macroaneurysm lumen represented by an almost complete hyperreflective tubular structure and the resolution of the neurosensory detachment. c A middle-phase angiogram of the OS after the 6th injection of intravitreal ranibizumab showing a full regression of the macroaneurysm. d OCT (Copernicus S-OCT) of the OS after the 6th injection of intravitreal ranibizumab showing the macroaneurysm as a shrunken hypereflective structure, resolution of the cystoid macular edema and only a few residual hard exudates.
Fig. 3
Fig. 3
OCT (iVue SD-OCT) of the OS 5 months after the last intravitreal ranibizumab injection, showing no recurrence of the retinal macroaneurysm.
See this image and copyright information in PMC

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