Ruptured Retinal Arterial Macroaneurysm after Panretinal Photocoagulation for Diabetic Retinopathy

Seon Tae Kim; Yoon Hyung Kwon

doi:10.3341/jkos.2017.58.5.606

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Kim and Kwon: Ruptured Retinal Arterial Macroaneurysm after Panretinal Photocoagulation for Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2017;58(5):606-610.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.5.606

Ruptured Retinal Arterial Macroaneurysm after Panretinal Photocoagulation for Diabetic Retinopathy

Seon Tae Kim, M.D., Yoon Hyung Kwon, M.D.

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Yoon Hyung Kwon, MD Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: 82-51-240-2776, Fax: 82-51-254-1987 E-mail: yhkwon@dau.ac.kr

This article has been supported by the Research Fund of the Dong-A University.

Received 15 December 20161 March 2017 Accepted 11 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of deterioration of a retinal arterial macroaneurysm after panretinal photocoagulation (PRP) for dia-betic retinopathy.

Case summary

A 70-year-old woman visited our clinic for evaluation of diabetic retinopathy. Fundus examination and fluo-rescein angiography showed severe non-proliferative diabetic retinopathy and PRP was planned for the patient. In addition, the patient was found to have a retinal arterial macroaneurysm on the superotemporal area of the retina on her right eye. However, the lesion was small and was located far from the macula, causing no symptoms; thus we decided to observe the patient over a period of time. Two months after PRP, the patient revisited the clinic complaining of acute visual loss. Fundus examination showed vitreous and retinal hemorrhage and optical coherence tomography revealed subretinal fluid in the corresponding area. This was considered to be due to aggravation of the pre-existing macroaneurysm. Intravitreal Bevacizumab injection, C₃ F₈ gas injection, and pars plana vitrectomy were performed. After absorption of the hemorrhage, barrier photocoagulation was per-formed around the retinal macroanerysm. The visual acuity improved and the retina remained stable through the most recent fol-low-up.

Conclusions

We experienced the rupture of a preexisting retinal arterial macroaneurysm in an asymptomatic patient after pan-retinal photocoagulation. PRP in diabetic patients could aggravate retinal arterial macroaneurysms. Therefore, it is necessary to carefully examine the patient for retinal macroaneurysms when planning a PRP for diabetic retinopathy.

Keywords: Diabetic retinopathy, Panretinal photocoagulation, Retinal arterial macroaneurysm, Vitreous hemorrhage

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Figure 1.

Initial clinical manifestations of the 70-year-old female patient. There are retinal multiple spot hemorrhages on fundus pho-tography (A), but subretinal fluid was not identified in both eye on optical coherence tomography scans (B). Small retinal arterial macroaneurysm (red circle) was found in the supero-temporal artery of the right eye on fluorescein angiography (C).

Figure 2.

Ruptured retinal arterial macroaneurysm. The fundus photograph shows the edematous macula, vitreous hemorrhage and retinal and subretinal hemorrhage at the posterior pole caused by a macroaneurysm in the superotemporal artery in right eye 2 months after panretinal photocoagulation (A). The optical coherence tomography images demonstrated a large amount of subretinal serous fluid (B).

Figure 3.

Aggravated vitreous hemorrhage after bevacizumab and C₃ F₈ gas injection. The fundus photography is invisible due to vitreous hemorrhage and opacity.

Figure 4.

The images after consecutive bevacizumab injection and vitrectomy. Vitreous hemorrhage and macula edema were im-proved but some exudates are seen at macular area on fundus photography (A) and optical coherence tomography (B).

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