PMC5478186_01
Findings and clinical course of patient 1 (left eye). a Findings at first presentation (best-corrected visual acuity, BCVA, 20/70). Upper row: color photograph (left) shows a retinal arterial macroaneurysm (RAM) located at the inferior temporal vessel arch with pre- and intraretinal hemorrhage, surrounding edema, and hard exudates. Fluorescein angiography (right) demonstrates a sharply defined hyperfluorescent RAM with surrounding blockage caused by hemorrhage. Middle row: infrared foto (IR) (left) and spectral-domain optical coherence tomography (SD-OCT) (right) of the fovea without edema. Lower row: IR (left) and SD-OCT (right) of the RAM showing intraretinal fluid and an elevation of the retina. b One month after the first intravitreal injection of 0.5 mg of ranibizumab (BCVA 20/100). IR (left) and SD-OCT (right) reveal stable foveal findings without exudation and a reduction of retinal edema in the region of the RAM (upper row: foveal scan; lower row: RAM). c One month after a second intravitreal injection of 0.5 mg of ranibizumab and focal laser photocoagulation (BCVA 20/30). IR (left) and SD-OCT (right) give no evidence for subfoveal edema and ongoing fluid reduction near the RAM (upper row: foveal scan; lower row: RAM). d Four months after c (BCVA 20/25). IR (left) and SD-OCT (right) show a constant foveal configuration and further regression of RAM (upper row: foveal scan; lower row: RAM). e Twelve months after second intravitreal injection of 0.5 mg of ranibizumab and focal laser photocoagulation (BCVA 20/25). Color photograph (upper row), IR (middle and lower row, left), and SD-OCT (middle and lower row, right) show a complete obliteration of RAM and resolution of the pre- and intraretinal hemorrhage as well as retinal edema. Additionally, a nearly located choroidal nevus is visible.
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There was a complete regression of the macular edema and thrombosis of the RAM (Fig. 1a-d).
Findings and clinical course of patient 2 (left eye). a Findings at first presentation (best-corrected visual acuity, BCVA, 20/200). Upper row: color photograph (left) presents a RAM located above the fovea with surrounding edema and pre- and intraretinal hemorrhage. Fluorescein angiography (right) signalizes a sharply defined hyperfluorescence. Middle row: infrared foto (IR) (left) and spectral-domain optical coherence tomography (SD-OCT) (right) of the fovea indicate intra- and subretinal fluid. Lower row: IR (left) and SD-OCT (right) of the RAM illustrate significant intraretinal fluid. b One month after intravitreal injection of 2.0 mg of aflibercept (BCVA 20/100). c Three months after b (BCVA 20/70). Complete regression of sub- and intraretinal fluid as well as involution of RAM is confirmed (IR left, SD-OCT right; upper row: foveal scan, lower row: RAM). d Twelve months after intravitreal injection of 2.0 mg of aflibercept (BCVA 20/50). Color photograph (upper row), IR (middle and lower row, left), and SD-OCT (middle and lower row, right) indicate a complete obliteration of RAM. Signs of relapse of pre- and intraretinal hemorrhage as well as sub- and intraretinal fluid are not present.
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Her BCVA increased after 4 weeks to 20/100, after 8 weeks to 20/70, and after 12 months to 20/50 (Fig. 2a-c).