Validity of focal laser photocoagulation followed by a single intravitreal ranibizumab injection for retinal artery macroaneurysm

Background To evaluate safety and efficacy of dual focal laser (DFL) followed by a single intravitreal ranibizumab injection for exudative retinal artery macroaneurysms (RAM). Methods Retrospective review of records of eyes with RAM; treated between February 2012 and November 2020; was done, to collect and analyze the following data: Treatment details, features of RAM, associated retinal disease, best-corrected visual acuity (BCVA), central macular thickness (CMT), signs of RAM involution, and possible complications. We enrolled cases that had been treated by Direct and perilesional focal laser, followed by a single intravitreal ranibizumab injection a few days later, and had been followed-up for at least 6 months. Outcome measures included: change in BCVA, change in CMT, and complications. Results 14 patients were enrolled. All cases were isolated RAM (without other retinal disease) with macular edema±hard exudates (100%). 12 cases (85.7%) were exudative, and 2 cases (14.3%) also had a hemorrhagic component (mixed type). Hemorrhagic macroaneurysms without exudation were not included in the study. RAM was fusiform in 12 cases (85.7%) and saccular in 2 cases (14.3%). RAM involved the upper temporal arcade in 10 cases (71.4%) and the lower temporal arcade in 4 cases (28.6%). RAM involved second order arteries in 10 cases (71.4%) and third order arteries in 4 cases (28.6%). Logarithm of the minimum angle of resolution (LogMAR) BCVA improved from an initial 0.71±0.35 to 0.27±0.26 at final follow-up. CMT was reduced from 417±82 μ to 285±31 μ at final follow-up. The mean interval between laser and ranibizumab injection was 3.2±2.9 days. The mean follow-up duration was 8.0±2.6 months. Involution/thrombosis- fibrosis of RAM was induced in all cases (100%). Conclusion Combined dual focal laser coagulation and single intravitreal ranibizumab injection for RAM are safe and effective, and may eliminate the need for repeated intravitreal injections. Isolated exudative macroaneurysms may be suitable for this combined approach.