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\begin{document}

\title{Need of preventive photocoagulation for retinal arterial macroaneurysm}



\author[1]{Daisuke Nagasato}%
\author[2]{Takuji Iwawaki}%
\author[1]{Hitoshi Tabuchi}%
\affil[1]{Tsukazaki Hospital}%
\affil[2]{Iwawaki Eye Clinic}%


\vspace{-1em}



  
  \date{May 19, 2024}


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\begin{abstract}
Retinal arterial macroaneurysm shows rapid vision loss when rupture
occurs; therefore, preventive photocoagulation should be considered, if
necessary.%
\end{abstract}%



\sloppy


\emph{Clinical Image}

Need of preventive photocoagulation for retinal arterial macroaneurysm

Daisuke Nagasato\textsuperscript{1,2*}, Takuji
Iwawaki\textsuperscript{3}, Hitoshi Tabuchi\textsuperscript{1,2}

\textsuperscript{1}Department of Ophthalmology, Tsukazaki Hospital,
Himeji, Japan

\textsuperscript{2}Department of Technology and Design Thinking for
Medicine, Hiroshima University Graduate School, Hiroshima, Japan

\textsuperscript{3}Iwawaki Eye Clinic, Asago, Japan

Contributors

Daisuke Nagasato, MD, PhD, E-mail:\emph{d.nagasato@tsukazaki-eye.net}

ORCID iD: 0000-0003-3956-9352

Takuji Iwawaki, MD, E-mail:\emph{hal99420@ybb.ne.jp}

Hitoshi Tabuchi, MD, PhD, EMBA,
E-mail:\emph{h.tabuchi@tsukazaki-eye.net}

ORCID iD: 0000-0002-9098-0430

\textsuperscript{*}Corresponding author

Daisuke Nagasato

68-1 Aboshi Waku, Himeji City, Hyogo Prefecture 671-1227, Japan

Tel: +81 79-272-8555; Fax: +81 79-272-8550

E-mail:\emph{d.nagasato@tsukazaki-eye.net}

\textbf{CONFLICT OF INTEREST}

There are no conflicts of interest.

\textbf{ETHICAL APPROVAL}

The authors have no ethical conflicts to disclose.

\textbf{CONSENT}

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

KEYWORDS

Photocoagulation; Retinal arterial macroaneurysm

KEY CLINICAL MESSAGE

Preventive photocoagulation for retinal arterial macroaneurysm might
have prevented vitreous hemorrhage.

\textbf{Abstract}

Retinal arterial macroaneurysm shows rapid vision loss when rupture
occurs; therefore, preventive photocoagulation should be considered, if
necessary.

\textbf{CASE DESCRIPTION}

A 66-year-old female underwent an annual ophthalmologic examination by
her family doctor. At her last visit, fundus examination revealed a
retinal arterial microaneurysm (RAM) and mild retinal hemorrhage of the
right eye on ultra-wide-field pseudo-color fundus images (Figure A). She
had no visual symptoms; therefore, her family doctor ordered a follow-up
visit. Five days later, she returned due to the feeling of a strong
floater in her right eye. Vitreous hemorrhage associated with the RAM
was observed (Figure B). Vitrectomy was performed for removing the
vitreous hemorrhage, and a laser was applied to the RAM.

There are many treatments for RAM, but no standard treatment protocol
has been established. Most RAMs have a benign course of thrombosis,
fibrosis, and spontaneous resolution, and the vision returns to its
previous state.\textsuperscript{1} Therefore, RAM with no symptoms is
generally followed up. When edema or exudates due to RAM cause vision
loss, photocoagulation is usually
considered.\textsuperscript{2}Photocoagulation may be performed directly
on macroaneurysms to facilitate involution.

Preventive photocoagulation for the RAM in the annual ophthalmologic
examination might have prevented vitreous hemorrhage.

\textbf{ACKNOWLEDGMENTS}

The authors would like to thank Enago (www.enago.jp) for the English
language review.

\textbf{AUTHOR CONTRIBUTIONS}

Daisuke Nagasato, MD, PhD has managed the patient; written the
manuscript; and critically reviewed the manuscript, references, and
images. Takuji Iwawaki, MD managed the patient. Hitoshi Tabuchi, MD,
PhD, EMBA has reviewed the manuscript.

\textbf{REFERENCES}

1. Speilburg AM, Klemencic SA. Ruptured retinal arterial macroaneurysm:
diagnosis and management. J Optom 2014;7:131--137.

2. Gurwood AS, Nicholson CR. Retinal arterial macroaneurysm: a case
report. J Am Optom Assoc 1998;69:41--48.



\textbf{Figure}

Ultra-wide-field pseudo-color fundus images of the patient's right eye.
Retinal arterial microaneurysm (RAM) and mild retinal hemorrhage were
revealed in superior-nasal retinal artery at an annual ophthalmologic
examination (A, arrow). After five days, vitreous hemorrhage occurred
from the RAM rupture (B).\selectlanguage{english}
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