J Korean Ophthalmol Soc.  2017 May;58(5):606-610. 10.3341/jkos.2017.58.5.606.

Ruptured Retinal Arterial Macroaneurysm after Panretinal Photocoagulation for Diabetic Retinopathy

• Kim ST
• Kwon YH

• KMID: 2378634
• DOI: http://doi.org/10.3341/jkos.2017.58.5.606

Abstract

PURPOSE
To report a case of deterioration of a retinal arterial macroaneurysm after panretinal photocoagulation (PRP) for diabetic retinopathy.
CASE SUMMARY
A 70-year-old woman visited our clinic for evaluation of diabetic retinopathy. Fundus examination and fluorescein 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, C₃F₈ gas injection, and pars plana vitrectomy were performed. After absorption of the hemorrhage, barrier photocoagulation was performed around the retinal macroanerysm. The visual acuity improved and the retina remained stable through the most recent follow-up.
CONCLUSIONS
We experienced the rupture of a preexisting retinal arterial macroaneurysm in an asymptomatic patient after panretinal 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.

Keyword

Diabetic retinopathy; Panretinal photocoagulation; Retinal arterial macroaneurysm; Vitreous hemorrhage

MeSH Terms

Absorption
Aged
Bevacizumab
Diabetic Retinopathy*
Female
Fluorescein Angiography
Follow-Up Studies
Hemorrhage
Humans
Light Coagulation*
Retina
Retinal Hemorrhage
Retinaldehyde*
Rupture
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Vitrectomy
Vitreous Hemorrhage
Bevacizumab
Retinaldehyde

Figure

• 

  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).

Reference

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