Direct Photocoagulation for Treating Microaneurysms with Hyperreflective Ring in Eyes with Refractory Macular Edema Associated with Branch Retinal Vein Occlusion

Hirofumi Sasajima; Masahiro Zako; Yoshiki Ueta; Hideo Tate; Chisato Otaki; Kenta Murotani; Takafumi Suzuki; Hidetoshi Ishida; Yoshihiro Hashimoto; Naoko Tachi

doi:10.3390/jcm11030823

Direct Photocoagulation for Treating Microaneurysms with Hyperreflective Ring in Eyes with Refractory Macular Edema Associated with Branch Retinal Vein Occlusion

J Clin Med. 2022 Feb 3;11(3):823. doi: 10.3390/jcm11030823.

Authors

Affiliations

¹ Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan.
² Department of Ophthalmology, Asai Hospital, Seto 489-0866, Japan.
³ Biostatistics Center, Kurume University, Kurume 830-0011, Japan.
⁴ Department of Ophthalmology, University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan.
⁵ Department of Ophthalmology, Kanazawa Medical University, Kahoku 920-0293, Japan.

Abstract

Microaneurysms (MAs) with hyperreflective rings are sometimes detected in eyes with refractory macular edema (ME) associated with branch retinal vein occlusion (BRVO) for more than 12 months after onset when examined using optical coherence tomography (OCT). We proposed that these MAs could result in refractory ME secondary to BRVO and hypothesized that OCT-guided direct photocoagulation of MAs could result in a reduction in refractory ME. Eleven eyes (from eleven different patients) with refractory ME associated with BRVO for more than 12 months following initial treatment were included. The mean number of MAs in each eye at baseline was 3.5 ± 2.0 (range, 1-8). The mean central subfield thickness, central macular volume, and parafoveal macular volume significantly decreased 6 months following initial direct photocoagulation when compared with those at baseline (baseline = 378.7 ± 61.8 μm, post-treatment = 304.2 ± 66.7 μm, p = 0.0005; baseline = 0.3 ± 0.049 mm³, post-treatment = 0.24 ± 0.053 mm³, p = 0.001; and baseline = 2.5 ± 0.14 mm³, post-treatment = 2.28 ± 0.15 mm³, p = 0.001, respectively). Moreover, the mean best-corrected visual acuity significantly improved 6 months following initial direct photocoagulation when compared with that at baseline (baseline = 0.096 ± 0.2 logarithm of the minimum angle of resolution (logMAR), post-treatment = 0.0077 ± 0.14 logMAR, p = 0.031). Direct photocoagulation could be suggested as a treatment option for refractory ME associated with BRVO in MAs with a hyperreflective ring on OCT.

Keywords: branch retinal vein occlusion; direct photocoagulation; hyperreflective ring; microaneurysms; optical coherence tomography; refractory macular edema.