Ophthalmology. Retina · 2026
Retinal Arterial Macroaneurysms: Clinical Features, Management, and Outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Zhang Charles, Bowers Katherine E, Khan Saara, AbouKasm Georges, Ersan Sinan, Nuesi Ronaldo, Williams Basil K, Yannuzzi Nicolas A, Flynn Harry W
Аннотация
PURPOSE: To describe baseline characteristics, management patterns, and long-term outcomes in a contemporary cohort of eyes with retinal arterial macroaneurysms (RAM) managed with observation versus treatment.
DESIGN: Retrospective cohort study.
SUBJECTS: Adult patients (aged ≥18 years) diagnosed with RAM at Bascom Palmer Eye Institute between January 2013 and December 2025.
METHODS: Baseline demographics, ocular findings, ancillary optical coherence tomography imaging, treatments, and visual outcomes were recorded. Continuous variables were compared using two-tailed Student t-tests and Wilcoxon signed-rank tests, as appropriate. Categorical variables were compared using chi-square or Fisher exact tests. Statistical significance was defined as P < 0.05.
MAIN OUTCOME MEASURES: Resolution of RAM, time to resolution, and changes in best-corrected visual acuity (BCVA) at final follow-up.
RESULTS: A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years (range 19-97), and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 110 eyes (68%) were managed with observation, and 51 eyes (32%) were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50, P < 0.0001) and more frequently reported macula-involving hemorrhage (78% vs. 52%; P = 0.0024) at the initial visit. In the observation cohort, 6% of eyes developed symptomatic hemorrhage prompting treatment, which occurred an average of 250 days after the initial diagnosis. In the treatment cohort, 59% of eyes were treated with antivascular endothelial growth factor monotherapy, 22% were treated with focal laser monotherapy, 16% were treated with combination therapy, and 4% were treated with vitrectomy with tissue plasminogen activator. Resolution of RAM, defined as fibrosis of the RAM with resorption of surrounding hemorrhage and/or edema, occurred in 100% of eyes in both cohorts of patients. BCVA at last follow-up was not statistically different between groups (20/50 observation vs. 20/70 treatment, P = 0.0730). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days; P = 0.0170).
CONCLUSIONS: This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously; however, selective treatment of eyes with more severe initial presentation may be beneficial.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective cohort study.
SUBJECTS: Adult patients (aged ≥18 years) diagnosed with RAM at Bascom Palmer Eye Institute between January 2013 and December 2025.
METHODS: Baseline demographics, ocular findings, ancillary optical coherence tomography imaging, treatments, and visual outcomes were recorded. Continuous variables were compared using two-tailed Student t-tests and Wilcoxon signed-rank tests, as appropriate. Categorical variables were compared using chi-square or Fisher exact tests. Statistical significance was defined as P < 0.05.
MAIN OUTCOME MEASURES: Resolution of RAM, time to resolution, and changes in best-corrected visual acuity (BCVA) at final follow-up.
RESULTS: A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years (range 19-97), and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 110 eyes (68%) were managed with observation, and 51 eyes (32%) were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50, P < 0.0001) and more frequently reported macula-involving hemorrhage (78% vs. 52%; P = 0.0024) at the initial visit. In the observation cohort, 6% of eyes developed symptomatic hemorrhage prompting treatment, which occurred an average of 250 days after the initial diagnosis. In the treatment cohort, 59% of eyes were treated with antivascular endothelial growth factor monotherapy, 22% were treated with focal laser monotherapy, 16% were treated with combination therapy, and 4% were treated with vitrectomy with tissue plasminogen activator. Resolution of RAM, defined as fibrosis of the RAM with resorption of surrounding hemorrhage and/or edema, occurred in 100% of eyes in both cohorts of patients. BCVA at last follow-up was not statistically different between groups (20/50 observation vs. 20/70 treatment, P = 0.0730). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days; P = 0.0170).
CONCLUSIONS: This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously; however, selective treatment of eyes with more severe initial presentation may be beneficial.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.