Effectiveness of combined laser photocoagulation therapy with intravitreal anti - VEGF in Retinal arterial macroaneurysms: case report

Background: Retinal arterial macroaneurysms (RAM) is a pathological dilatation of retinal arterial vessel. Argon laser photocoagulation has been for a long time the gold standard of many vascular diseases of the retina such as macroaneurysm. From this work emerges how the introduction of intravitreal anti-VEGF therapies have enhanced the 'effectiveness of the combination of argon laser photocoagulation in cases of persistent retinal edema, we present the case of a retinal macroaneurysm with macular hemorrhage focus and oedema in a patient with a history of systemic arterial hypertension. Methods: A 77 year-old woman patient reported sudden decline in visual acuity in the left eye; the best corrected visual acuity (BCVA)was 1/10 in left eye. Fluorescein angiography (FAG) resulted in diagnosis of Macroaneurysm at the posterior pole with macular hemorrhage focus and oedema. The patient was treated with laser treatment in the left eye; after 30 days, the visual acuity was 1/50 and at optical coherence tomography (OCT) the retinal profile was significantly altered. After 30 days, a single intravitreal ranibizumab injection was performed and, after 7 days, visual acuity was 1/10. After 24 months from ranibizumab-based therapy the final visual acuity was 10/10 and OCT examination revealed a normal retinal profile. Conclusion: In this case report the association of argon laser photocoagulation with intravitreal anti-VEGF injection has been proven to be effective and safe in case of persistent retinal oedema.