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Zhou Z, Lin Z, Guo B, Yang C, Wu X, Sun B, Liu Y, Wu R. RETINAL ARTERIAL MACROANEURYSM COMBINED WITH BRANCH RETINAL ARTERY OCCLUSION: Literature Review. Retina 2024; 44:1649-1654. [PMID: 39151180 DOI: 10.1097/iae.0000000000004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE To summarize the causes of retinal arterial microaneurysm combined with branch retinal artery occlusion. METHODS The case reports of retinal arterial microaneurysm combined with branch retinal artery occlusion were searched in PubMed, Web of Science, and CNKI databases before May 1, 2024. A total of nine participants from nine case reports were included to analyze factors leading to complications. RESULTS The reasons for this complication are as follows: complications during photocoagulation therapy. Intraretinal hemorrhage and exudation result in compression of adjacent or distal arteries, resulting in branch retinal artery occlusion. Embolus dislodgement or intraarterial embolus formation can block the artery, damage the wall, and provide conditions for the development of retinal arterial microaneurysm. In addition, it is necessary to be alert to the optic disk macroaneurysm, if hemorrhage or embolus formation in the macroaneurysm will affect the blood supply of the downstream artery, affecting a large range of the retina. CONCLUSION Based on the review of case reports, we found that retinal arterial microaneurysm and branch retinal artery occlusion can cause each other. Acute vision loss can result when a complication occurs. In addition, retinal vascular diseases can reflect the whole body, suggesting that ophthalmologists need to pay attention not only to the patient's fundus but also to the patient's systemic diseases.
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Affiliation(s)
- Zigan Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Meng Y, Xu Y, Li L, He L, Yi Z, Chen C. Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review. BMC Ophthalmol 2022; 22:461. [PMID: 36451117 PMCID: PMC9710132 DOI: 10.1186/s12886-022-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature. CASE PRESENTATION A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole. CONCLUSIONS This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
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Affiliation(s)
- Yang Meng
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Yishuang Xu
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu Li
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Lu He
- grid.412632.00000 0004 1758 2270Physical Examination Center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Zuohuizi Yi
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
| | - Changzheng Chen
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China
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Wang C, Cao G, Xu X, Wang J, Zhang S. Outcomes of combined treatments in patients with retinal arterial macroaneurysm. Indian J Ophthalmol 2021; 69:3564-3569. [PMID: 34826996 PMCID: PMC8837312 DOI: 10.4103/ijo.ijo_612_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: To evaluate the outcome of the combined approach between intravitreal ranibizumab (IVR) and focal laser photocoagulation (FLP) in the treatment of symptomatic retinal arterial macroaneurysm (RAM). Methods: A total of 10 patients were included in this clinical case series report. They were diagnosed with symptomatic RAM (one eye in each) and assessed by a comprehensive ophthalmologic examination, including fluorescein angiography (FA), optical coherence tomography angiography (OCT-A), and indocyanine green angiography (ICGA). All patients were treated with an IVR followed by an FLP 2 weeks later. If necessary, a second IVR was given 1 month after the first one (or 2 weeks after the first FLP), which was followed by a second FLP treatment 2 weeks later in the needed cases. All cases were followed up for 6 months after the last treatment. Results: Both the retina hemorrhage and edema were resolved by the treatment. No ocular and/or systemic side effects were evident, and no recrudescence of RAM was seen within the 6 months of follow-up. Conclusion: The combined treatment of IVRs and FLPs was successful in the management of symptomatic RAM.
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Affiliation(s)
- Chenghu Wang
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Guofan Cao
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangzhong Xu
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, Canada
| | - Shu Zhang
- Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
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Quiroz-Mendoza JL, Valera-Cornejo DA, García-Roa M, Ramírez-Neria P, Villalpando-Gómez Y, Romero-Morales V, García-Franco R. Different approaches in the management of macular hemorrhage: Case reports and a literature review. Medwave 2020; 20:e7831. [PMID: 32225130 DOI: 10.5867/medwave.2020.02.7831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/28/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Macular hemorrhages result in a sudden and profound loss of vision. The primary treatment modalities include observation, intravitreal injection of antiangiogenic drugs, neodymium-doped yttrium aluminum garnet hialoidotomy, intravitreal injection of gas with or without tissue plasminogen activator, as monotherapy or combined with surgery. In this paper, we report four cases of macular hemorrhages of different causes treated with different approaches, and we review the literature in this regard. Case presentation All four patients presented different causes of macular hemorrhage. The first case had a preretinal hemorrhage due to a Valsalva retinopathy and was treated with surgery. Case 2 had a multilevel macular hemorrhage due to a rupture of a retinal arteriolar macroaneurysm and was treated with pneumatic displacement, laser, and intravitreal ranibizumab. Case 3 presented an extensive subretinal hemorrhage due to a choroidal rupture after high-energy ocular trauma that was also successfully treated with surgery. The last case was a preretinal hemorrhage due to diabetic retinopathy managed with neodymium-doped yttrium aluminum garnet laser. Different treatment approaches were successfully performed in all cases with good outcomes. Conclusion There is an extensive range of options available for the management of macular hemorrhages, and the best option depends on the characteristics of each particular case. Proper and timely management of these diseases can achieve an excellent visual outcome, especially if the location of the hemorrhage is preretinal.
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Affiliation(s)
- Jaime Leonel Quiroz-Mendoza
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México. ORCID: 0000-0003-4460-7456
| | - Diego Alejandro Valera-Cornejo
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México. ORCID: 0000-0001-5125-1342
| | - Marlon García-Roa
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México.
| | - Paulina Ramírez-Neria
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México
| | - Yolanda Villalpando-Gómez
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México
| | - Verónica Romero-Morales
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México
| | - Renata García-Franco
- Instituto Mexicano de Oftalmología I.A.P, Querétaro, México. Universidad Nacional Autónoma de México, CDMX, México
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Barnes RFW, Cramer TJ, Hughes TH, von Drygalski A. The hypertension of hemophilia is associated with vascular remodeling in the joint. Microcirculation 2017. [PMID: 28627086 DOI: 10.1111/micc.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hemophilic arthropathy is associated with pronounced vascular joint remodeling. Also, compared to the general population, PWH have a higher prevalence of hypertension not explained by usual risk factors. As vascular remodeling in various vascular beds is a hallmark of hypertension, we hypothesized that vascular joint remodeling is associated with elevated blood pressures and hypertension. METHODS Elbows, knees, and ankles of 28 adult PWH were evaluated for vascular abnormalities with MSKUS/PD, as well as for radiographic and clinical status and pain. Logistic and linear regression models were fitted to examine associations between hypertension, blood pressure, and PD score. RESULTS The extent of vascular abnormalities was associated with hypertension and blood pressures. Hypertensive patients had a higher PD score compared to nonhypertensive patients, and the risk of hypertension increased steeply with PD score. SBP was also strongly associated with PD score, while DBP was only weakly associated. CONCLUSIONS Vascular remodeling in hemophilic joints is associated with hypertension and elevated blood pressures. As hypertension is a grave risk factor for intracranial hemorrhage, a prominent cause of mortality in hemophilia patients, future studies are needed to address the causal pathways between vascular joint remodeling and blood pressure.
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Affiliation(s)
- Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Thomas J Cramer
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Tudor H Hughes
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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Menezes C, Carvalho R, Teixeira C, Lemos JA, Gonçalves R, Coelho P, Lima A. Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab. Case Rep Ophthalmol 2015; 6:170-5. [PMID: 26120315 PMCID: PMC4478313 DOI: 10.1159/000431353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab. METHODS We report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented. RESULTS His best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment. CONCLUSIONS Intravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.
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Affiliation(s)
- Carlos Menezes
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Rui Carvalho
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Carla Teixeira
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - José Alberto Lemos
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Rita Gonçalves
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Pedro Coelho
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - André Lima
- Department of Ophthalmology, Pedro Hispano Hospital, Matosinhos, Portugal
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