Bevacizumab Monotherapy for Macular Hemorrhage Secondary to a Retinal Arterial Macroaneurysm

Ji Soo Kim; Ju Byung Chae; Jin Young Kim; Sung Min Hyung; Dong Yoon Kim

doi:10.3341/jkos.2019.60.4.323

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Kim, Chae, Kim, Hyung, and Kim: Bevacizumab Monotherapy for Macular Hemorrhage Secondary to a Retinal Arterial Macroaneurysm

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(4): 323-330.

Published online: 17 April 2019

DOI: https://doi.org/10.3341/jkos.2019.60.4.323

Bevacizumab Monotherapy for Macular Hemorrhage Secondary to a Retinal Arterial Macroaneurysm

Ji Soo Kim, MD¹, Ju Byung Chae, MD, PhD¹, Jin Young Kim, MD², Sung Min Hyung, MD, PhD¹, Dong Yoon Kim, MD, PhD¹

¹Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

²Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

Address reprint requests to Dong Yoon Kim, MD, PhD. Department of Ophthalmology, Chungbuk National University Hospital, #776 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea. Tel: 82-43-269-6146, Fax: 82-43-269-5263, umlover9@gmail.com

Received 2 August 2018 Revised 10 October 2018 Accepted 18 March 2019

The Korean Ophthalmological Society

(open-access):

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 evaluate the clinical features of intravitreal bevacizumab injection in patients with macular hemorrhage (submacular or subinternal limiting membrane hemorrhage) secondary to a retinal arterial macroaneurysm.

Methods

We retrospectively reviewed the medical records of 17 eyes of 17 patients who underwent intravitreal bevacizumab injection with macular hemorrhage secondary to retinal arterial macroaneurysm. We evaluated the improvement of visual acuity and changes in central retinal thickness after intravitreal injections of bevacizumab. According to the final visual acuity, the characteristics of the good and poor visual prognoses groups were compared.

Results

The mean age of patients (17 eyes) who underwent intravitreal bevacizumab treatment for macular hemorrhage secondary to retinal arterial macroaneurysm was 78.47 ± 7.84 years. The mean follow-up period was 3.99 ± 2.99 months, and the mean number of injections of bevacizumab was 2.12 ± 1.36. There were significant improvements in visual acuity and central retinal thickness, and the duration from symptom onset to treatment was shorter in patients with good visual prognoses.

Conclusions

Intravitreal bevacizumab injection alone was effective for improving visual acuity and decreasing central retinal thickness in patients with macular hemorrhage secondary to retinal arterial macroaneurysms.

Keywords: Bevacizumab, Retina, Retinal arterial macroaneurysm, Retinal hemorrhage, Visual acuity

Figures and Tables

Figure 1

Images from the right eye of a 83-year-old woman with symptomatic retinal arterial macroaneurysm treated with intravitreal bevacizumab injections (patient 3). Initial visual acuity was hand motion. Duration from symptom onset to treatment was 10 days. (A, D) Fundus photograph and optical coherence tomography (OCT) obtained at the initial visit showing submacular and sub-inner limiting membrane hemorrhage with subretinal fluid secondary to the retinal arterial macroaneurysm. (C) Fluorescein angiography showing a focal hyperfluorescence attributable to macroaneurysm. (B, E) Fundus photograph and OCT 3 month after the 3 intravitreal bevacizumab injection showing resolution of the retinal hemorrhages, obliteration of the macroaneurysm, and flattened macular. Final best corrected visual acuity was 20/667 (Snellen).

Figure 2

Images from the left eye of a 88-year-old woman with symptomatic retinal arterial macroaneurysm treated with intravitreal bevacizumab injections (patient 11). Initial visual acuity was counting fingers. Duration from symptom onset to treatment was 3 days. (A, B) Fluorescein and indocyanine green angiography showing a focal hyperfluorescence attributable to macroaneurysm. (C, E) Fundus photograph and optical coherence tomography (OCT) obtained at the initial visit showing submacular and sub-inner limiting membrane hemorrhage secondary to the retinal arterial macroaneurysm. Initial visual acuty was counting fingers. (D, F) Fundus photograph and OCT 6 month after the 4 intravitreal bevacizumab injection showing resolution of the retinal hemorrhages, obliteration of the macroaneurysm, and flattened macular. Final best corrected visual acuity was 20/67 (Snellen).

Table 1

Baseline characteristics of patient with the macular hemorrhage secondary to the retinal arterial macroaneurysm

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

RAM = retinal arterial macroaneurysm.

Table 2

Comparison of baseline and final best corrected visual acuity and central retinal thickness

Values are presented as mean ± standard deviation unless otherwise indicated.

BCVA = best corrected visual acuity; logMAR = the logarithm of the minimal angle of resolution.

^*The significance of the difference was assessed by paired t-test.

Table 3

Comparison of two groups according to final best corrected visual acuity

Values are presented as mean ± standard deviation unless otherwise indicated. ‘Group A’ means good visual prognosis group. ‘Group B’means poor visual prognosis group.

M/F = male/female; RAM = retinal arterial macroaneurysm; BCVA = best corrected visual acuity; logMAR = the logarithm of the minimal angle of resolution; CRT = central retinal thickness.

^*The significance of the difference was assessed by the Mann-Whitney U test; ^†The significance of the difference was assessed by the Fisher's exact test; ^‡The significance of the difference was assessed by the linear by linear association.

Notes

This work was supported by the Overseas dispatch Program of Chungbuk National University in 2015.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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