Título

ANTIANGIOGENIC THERAPY FOR MACULAR EDEMA FOLLOWING RUPTURED ARTERIAL MACROANEURYSM

Introdução / Purpose

Retinal arterial macroaneurysms are saccular or fusiform dilations of acquired character that affect mainly women between 60 and 80 years old. They are usually located in the first three arterial bifurcations, and are, in most cases, isolated and unilateral. The main complication is their rupture and consequent bleeding and exudation. Thus, depending on their location and activity level, if there is macular involvement, there may be a significant visual loss.

Material e Método / Methods

Case report

Resultados / Results

A 70-year-old female patient came for consultation with complaints of poor visual acuity in the left eye for 3 months.
The patient presented, at the ophthalmological examination, corrected visual acuity of 20/30-2 in the right eye and 20/200 in the left eye.
In retinal mapping in the left eye, the patient presented transparent vitreous, presence of macular hard exudates, macular edema, hemorrhage in the area of the superior-temporal arcade.
The Fluorescein angiography revealed in the left eye a ruptured arterial macroaneurysm in the superior temporal vascular arcade, significant contrast leakage from the vascular lesion, including the macula.
The Optical Coherence Tomography (OCT) showed hyporeflective intraretinal cystoid spaces corresponding to intraretinal fluid accumulation, as well as subretinal hyporeflective image presenting serous retinal detachment in the macular region and foveal thickness of 474 microns.
The patient was then treated with 3 intravitreal injections of Aflibercept, monthly interval between as applications.
Two months after the last application of the antiangiogenic medication there was a good functional response: visual acuity of 20/30; and excellent anatomical response.

Discussão e Conclusões / Discussion

In the patient above, diagnosed with macular edema secondary to a ruptured arterial macroaneurysm, the treatment with intravitreous aflibercept evolued with an excellent functional (visual acuity improvement from 20/200 to 20/30) and anatomical response (resolution of exudative signs on OCT).

Palavras Chave

macular edema; ruptured arterial macroaneurysm; intravitreous; aflibercept

Area

CLINICAL RETINA