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Asia Pac J Ophthalmol (Phila). 2017 Sep-Oct;6(5):444-449. doi: 10.22608/APO.201766. Epub 2017 Aug 22.

Laser and Anti-Vascular Endothelial Growth Factor Agent Treatments for Retinal Arterial Macroaneurysm.

Chen YY1, Lin LY1,2, Chang PY1,3, Chen FT1,3, Mai ELC1, Wang JK1,3,4,5,6.

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Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Medicine, Taipei Medical University, Taipei City, Taiwan.
Department of Medicine, National Taiwan University, Taipei City, Taiwan.
Department of Medicine, National Yang Ming University, Taipei City, Taiwan.
Departments of Healthcare Administration and Nursing, Oriental Institute of Technology, New Taipei City, Taiwan.
Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan.



To describe the efficacy of laser and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents for patients with symptomatic retinal arterial macroaneurysm (RAM).


From 2009 to 2016, we collected patients with exudative or hemorrhagic RAM all treated by focal laser photocoagulation.


Nd:YAG laser was performed in patients with subinternal limiting membrane (sub-ILM) hemorrhage. Intravitreal anti-VEGF agents were given in eyes with macular exudation as adjuncts. Changes of visual acuity and central foveal thickness before and after treatment were recorded and compared with Wilcoxon signed-rank test.


Thirty-five eyes that underwent a single session of laser photocoagulation for RAM resulted in macroaneurysm regression. The hemorrhagic group included 24 eyes having ruptured macroaneurysms without macular exudation. Five eyes with simultaneous sub-ILM hemorrhage receiving Nd:YAG laser membranotomy had resolution of preretinal hemorrhage. Exudative RAM having cystoid macular edema or submacular fluid with or without ruptured macroaneurysms was treated by focal laser photocoagulation alone in 3, or combined with single intravitreal anti-VEGF agent in 8 eyes. All patients had significantly improved vision when comparing visual acuity at baseline and final follow-up (P = 0.00016). Significant reduction of macular thickness was also observed after laser monotherapy or combined treatment in exudative RAM (P = 0.018).


Focal laser photocoagulation was helpful for the management of ruptured or leaky RAM. Combined focal laser and intravitreal anti-VEGF agents could better reduce macular exudation caused by RAM. Additionally, Nd:YAG laser was a safe and effective method to remove the sub-ILM hemorrhage caused by RAM.


aflibercept; argon laser; bevacizumab; retinal arterial macroaneurysm

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