Evaluation of ocular blood flow over time in a treated retinal arterial macroaneurysm using laser speckle flowgraphy

Purpose

To report the changes over time in ocular blood flow quantified by laser speckle flowgraphy (LSFG) in a treated large retinal arterial macroaneurysm (RAM).

Observations

A 72-year old female presented with sudden decreased vision in the left eye. Fundus examination revealed a RAM and vitreous hemorrhage (VH), which worsened over one month. A vitrectomy was performed to remove the VH, with 20% sulfur hexafluoride injected into the vitreous cavity. The VH recurred two weeks later and the RAM was found to have enlarged from one-quarter disc diameter (DD) to three DDs during a second vitrectomy. The RAM subsequently shrunk spontaneously to one DD without recurrent VH during the following 2 weeks. Beginning 4 weeks after the second vitrectomy we performed serial LSFG examinations of the RAM and found that the mean blur rate (MBR) of the RAM and retinal flow volume (RFV) in both the feeding arteriole and draining venule decreased as the RAM continued to involute.

Conclusions and importance

MBR and arteriolar and venular RFV measured by LSFG decreased with RAM involution. Longitudinal followup of blood flow by LSFG may be useful for noninvasive evaluation of the stability of RAMs.

Retinal racemose hemangioma with retinal artery macroaneurysm: Optical coherence tomography angiography (OCTA) findings

Purpose

To describe a rare case of retinal racemose hemangioma (RRH) with retinal artery macroaneurysm (RAM) and its optical coherence tomography angiography (OCT-A) finding before and after treatment.

Observations

Congenital arteriovenous (AV) communications or RRH is a rare developmental anomaly associated with various ocular conditions. RRH alone is usually asymptomatic, and vision loss occurs when associated with other ocular complications like retinal vein occlusion, hemmorage, macular edema and macroaneurysm. In this communication we describe a case of a 44-year-old female having RRH who presented with active, leaking RAM with subretinal hemmorage. OCT-A through the lesion demonstrated an active aneurysm which on subsequent treatment with anti VEGF and focal laser photocoagulation showed involution of aneurysm.

Conclusions and importance

RRH is usually asymptomatic and may be associated with vision threatening ocular complications like RAM. OCT-A helps in giving additional dynamic blood flow information in RAM.

Intravitreal bevacizumab in congenital retinal macrovessel with retinal arteriolar macroaneurysm

Congenital retinal macrovessel (CRM) refers to an aberrant vessel, usually a vein, which traverses the macula and supplies both sides of the horizontal raphe. It is a rare condition, mostly asymptomatic and discovered on routine examination. We describe a case of both arterial and venous CRM with a macroaneurysm along the arterial CRM that presented with decreased vision due to prominent lipid exudation at the macula. Treatment with intravitreal bevacizumab resulted in a favourable anatomical as well as functional outcome. To the best of our knowledge, this is the first report of this unusual presentation of CRM, and its successful management with intravitreal bevacizumab.