Spontaneous resolution of treatment‐resistant foveal capillary macroaneurysms in retinal diseases

• Published in: Acta ophthalmologica (Oxford, England) England), 2022-12, Vol.100 (S275), p.n/a
• Main Author: Braham, Imene Zhioua
• Format: Article
• Language: English
• Subjects: Angiography; Dexamethasone; Diabetes mellitus; Edema; Occlusion; Retina; Vascular endothelial growth factor
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.0811

Purpose: Capillary macroaneurysms (CMAs), may be observed in many retinal diseases causing chronic macular edema. A targeted photocoagulation can be efficient to close extrafoveal CMAs. However, treatment of foveal CMAs can be challenging. We report 2 cases of foveal CMAs with chronic edema resistant to intravitreal injections (IVI), which spontaneously resolved after discontinuation of treatment. Methods: Patients with foveal aneurysms greater than 150 μm in diameter, related to retinal diseases and treatment‐resistant were evaluated with ophthalmologic examination and multimodal imaging. Results: Case 1: a 74‐year old female with retinal branch vein occlusion complicated with chronic macular edema was referred for treatment. Foveal macroaneurysm was detected on indocyanine green angiography (ICGA) and was resistant to ranibizumab followed by aflibercept monthly IVI. Six months after stopping treatment, macular edema spontaneously resolved with occlusion of the CMA. Case 2: a 82‐year old patient was treated for a chronic diabetic macular edema on his left eye. He received regular IVI of ranibizumab, aflibercept and dexamethasone implant without improvement. A retrofoveal CMA was noted on ICGA. After 4 months without IVI, the central macular thickness and the vision improved spontaneously. Conclusions: Chronic macular edema related to foveal CMAs is usually resistant to anti‐VEGF and steroid intravitreal injections. In some cases, spontaneous resolution of the macroaneurysm can occur when treatment is stopped.