Outcomes of Combined Therapy With Focal Laser and Intravitreal Bevacizumab for Retinal Arterial Macroaneurysm: A Case Series

Retinal arterial macroaneurysms (RAMAs) are uncommon vascular abnormalities that can lead to significant visual impairment if left untreated. While various management strategies exist, there is no universally accepted standard of care, and treatment is often guided by the severity of associated hemorrhage and fluid accumulation. The purpose of this case series is to evaluate and discuss the management and the use of combination therapy in the form of focal laser (FL) treatment and intravitreal anti-vascular endothelial growth factor (VEGF) injections in patients with retinal arterial macroaneurysms (RAMAs). A retrospective chart review was conducted on the patients, including their clinical histories, comorbidities, age, and treatment methods. Baseline and posttreatment vision were obtained, and a detailed literature review was conducted emphasizing treatment and outcomes. All three patients had a complete resolution of the subretinal and intraretinal fluid associated with the RAMA with combination therapy with considerable improvement in vision. The average improvement in visual acuity (VA) across the three cases was 0.55 logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CRT) decreased on average by 275.7 µm at the three-month mark. Combination therapy with anti-VEGF and focal laser appears to be an effective and definitive treatment for retinal arterial macroaneurysms.