Title

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR ASSOCIATED WITH LASER FOR EXUDATIVE RETINAL ARTERIAL MACROANEURYSM

Summary

A fifty-six-year-old woman presented at the ophthalmic emergency room complaining of a sudden painless central scotoma in her right eye for three days. Her medical history was positive for systemic arterial hypertension treated with losartana. She denied any ocular disease. Her best-corrected visual acuity was counting fingers at 30 cm in her right eye and 20/25 in her left eye. Slit-lamp biomicroscopy was unremarkable and intraocular pressures were 16 mmHg bilaterally. Left eye fundus examination was unremarkable. Right eye fundoscopy revealed macular edema and retinal hemorrhage associated with macroaneurysm in the infratemporal artery. Fluorescein angiography showed hypofluorescence from blockage from retinal hemorrhage and a round hyperfluorescence lesion representing the retinal macroaneurysm. Ocular coherence tomography demonstrated foveal neurosensory detachment, cystoid spaces and hyperreflective dots in the retina and central retinal thickness. After obtaining the written consent, patient was treated by focal laser photocoagulation combined with 2 monthly doses of intravitreal bevacizumab in her right eye. Threshold laser was performed around the macroaneurysm with confluent pattern and the following settings: spot size of 100 μm, duration of 0.2 seconds, 160 mW of power until retinal whitening. After treatment, her BCVA improved to 20/32, and the macroaneurysm and OCT findings showed features of regression.

Area

CLINICAL CASE

Authors

Annelise Nicotti Gonçalves, Rodrigo Jorge