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RETINAL CAPILLARY MACROANEURYSMS

Spaide, Richard F., MD*; Barquet, Luis Arias, MD, PhD

doi: 10.1097/IAE.0000000000002406
Original Study: PDF Only

Purpose: To investigate eyes with solitary large aneurysms arising from retinal capillaries.

Methods: Consecutive patients with aneurysms greater than 200 µm in diameter were evaluated with a comprehensive ophthalmologic examination including optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography. The aneurysms were solitary in the sense, and there was only one aneurysm larger than the threshold diameter and a few or no other aneurysms.

Results: There were 5 patients, 3 male patients, who had aneurysms that reached a maximal mean size of 273.4 µm. One patient had stable diabetic retinopathy and had a documented growth of a capillary aneurysm to 331 µm over an 8-year 7-month period until the aneurysm was associated with widespread edema. The remaining 4 patients did not have diabetes or any discernable retinal vascular disease. Anti–vascular endothelial growth factor treatment was associated with a partial response in one patient and no apparent response in the others. Laser photocoagulation of the aneurysms resulted in resolution of the edema and involution of the lesions.

Conclusion: Large aneurysms arising from retinal capillaries occur and have a candidate name of retinal capillary macroaneurysms. Histologic evaluation of retinal capillary aneurysms shows the presence of matrix metalloproteinase-9, which may function to decrease the wall strength in the face of increasing wall tension from aneurysmal expansion, as predicted by LaPlace's law. Thus, retinal capillary macroaneurysms may have multiple forces driving their formation.

Large unitary aneurysms may form from retinal capillaries and are not necessarily associated with any other retinal vascular disease. Laser photocoagulation resulted in involution of the lesion with cessation of edema.

*Vitreous, Retina, Macula Consultants of New York, New York; and

Department of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, Spain.

Reprint requests: Richard F. Spaide, MD, Vitreous, Retina, Macula Consultants of New York, 460 Park Avenue, New York, NY 10022; e-mail: rick.spaide@gmail.com

Supported by the Macula Foundation, Inc., New York, NY, which had no control over content.

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

© 2018 by Ophthalmic Communications Society, Inc.