Anti-VEGFs treat symptomatic retinal arterial macroaneurysms
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Macular edema and visual acuity improved in eyes with symptomatic retinal arterial macroaneurysms treated with anti-VEGF injections, according to a study.
The improvement can be attributed to anti-VEGFs’ “vasoconstrictive effect and their stabilizing effect on the blood retinal barrier while retinal macroaneurysms are undergoing progressive fibrosis and closure,” J. Fernando Arevalo, MD, PhD, FACS, said at the virtual American Society of Retina Specialists meeting.
Arevalo and colleagues included 32 eyes of 32 patients in a retrospective, multicenter, interventional study of anti-VEGF injections for symptomatic retinal arterial macroaneurysms (RAM). The study evaluated the risk and benefits of off-label anti-VEGF therapy in eyes with RAM and visual loss.
Eyes were treated with a mean of 2.7 injections over a mean follow-up of 16.6 months. Subretinal fluid and hemorrhage were the main factors determining when to re-treat, Arevalo said in discussion of the study.
Lucentis (ranibizumab, Genentech) was used in 14 patients, Avastin (bevacizumab, Genentech) in 16 patients and Eylea (aflibercept, Regeneron) in two patients. Thirteen eyes received a single injection, while the rest underwent multiple injections.
Initial best corrected visual acuity (BCVA) correlated significantly with RAM size and distance to the macula (P = .02). Mean central macular thickness statistically significantly decreased from baseline by 131 µm,180 µm and 211 µm at 1, 2 and 3 months, respectively, after the first anti-VEGF injection (P < .001). Mean BCVA statistically significantly improved by 0.47 logMAR at 2 months and 0.38 logMAR at 3 months (P = .005).
Additionally, the anti-VEGF injection response correlated significantly with the RAM size (P = .04) and distance to the macula (P = .009).
“Close proximity of RAM to the fovea would favor anti-VEGF treatment, as it is free of locally destructive side effects. Resolution of perianeurysmal exudates or hemorrhages and gradual obliteration of RAM seem accelerated with anti-VEGF therapy, avoiding retinal damage from laser photocoagulation,” Arevalo said.
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Arevalo JF. Intravitreal anti-VEGF injections for exudative retinal arterial macroaneurysms: Results of an international multicenter study. Presented at: American Society of Retina Specialists annual meeting; July 24-26, 2020 (virtual meeting).
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