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Mansour, Ahmad M. MD*,†; Foster, Robert E. MD; Gallego-Pinazo, Roberto MD§; Moschos, Marilita M. MD; Sisk, Robert A. MD; Chhablani, Jay MS, DNB**; Rojanaporn, Duangnate MD††; Sujirakul, Tharikarn MD††,‡‡; Arevalo, J. Fernando MD§§,¶¶; Lima, Luiz H. MD***; Wu, Lihteh MD†††; Charbaji, Abdulrazzak PhD‡‡‡,§§§; Saatci, Ali O. MD¶¶¶; Mansour, Hana A. BS*; Martinez-Rubio, Clara MD§; Patel, Yogin MD; Gangakhedkar, Sankeert MS, DNB**

doi: 10.1097/IAE.0000000000002131
Original Study

Purpose: There is no established therapy for exudative-hemorrhagic complications in primary retinal arteriolar macroaneurysm (RAM).

Methods: Retrospective multicenter interventional study of anti-vascular endothelial growth factor in symptomatic RAMs. Central macular thickness in μm and best-corrected visual acuity in logMar were correlated with the RAM size and distance to the macula. Statistical analyses were performed using paired comparisons and Pearson correlation.

Results: Thirty-two eyes (32 patients) were treated with a mean of 2.7 injections over a mean follow-up of 16.6 months. Initial best-corrected visual acuity correlated with the RAM size and distance to the macula (P = 0.02). Central macular thickness decreased by 131,180, and 211 μm at 1, 2, and 3 months after the first injection (P < 0.001). Best-corrected visual acuity improved by 0.47 and 0.38 Early Treatment Diabetic Retinopathy Study lines at 2 and 3 months (P = 0.005). Anti-vascular endothelial growth factor response correlated with the RAM size (P = 0.04) and the distance to the macula (P = 0.009).

Conclusion: Symptomatic RAMs can be treated successfully with anti-vascular endothelial growth factor injections, leading to a decrease in macular edema.

Intravitreal vascular endothelial growth factor antagonists improve visual acuity and decrease macular edema through their vasoconstrictive effect and their stabilizing effect on the blood retinal barrier while retinal macroaneurysms are undergoing progressive fibrosis and closure.

*Department of Ophthalmology, American University of Beirut, Beirut, Lebanon;

Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon;

Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio;

§Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain;

Department of Ophthalmology, University of Athens, Athens, Greece;

**Department of Vitreoretinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India;

††Department of Ophthalmology, Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand;

‡‡ Department of Ophthalmology,Rutnin Eye Hospital, Bangkok, Thailand;

§§Department of Ophthalmology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland;

¶¶Retina Division, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland;

***Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil;

†††Vitreoretinal Associates of Costa Rica, San José, Costa Rica;

‡‡‡Department of Statistics and Research Methodology, Lebanese American University, Beirut, Lebanon;

§§§Department of Statistics and Research Methodology, Lebanese University, Beirut, Lebanon; and

¶¶¶Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.

Reprint requests: Ahmad M. Mansour, MD, Department of Ophthalmology, American University of Beirut, Beirut POB 113-6044, Lebanon; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.