Supplementary Material for: The management of two cases with retinal arterial macroaneurysm by anti- vascular endothelial growth factor

Introduction: We report to describe two cases of age-related macular degeneration and one case of diabetic macular edema with concomitant retinal arterial macroaneurysm(RAM)that were treated with anti-vascular endothelial growth factor(VEGF)intravitreal injections. Case Presentation: Case 1 involved a 71-year-old woman with a 30 years history of diabetes who was undergoing dialysis. Pretreatment visual acuity in the right eye was 0.4. FA showed that numerous microaneurysms and RAM located at a distance of two papillary diameter from the macular area. Diabetic macular edema was diagnosed. After 13 anti VEGF injections, the macular edema resolved, microaneurysms decreased and the RAM also disappeared. Visual acuity in the right eye improved to 0.7. Case 2 involved an 81-year-old woman receiving treatment for disorders including hypertension and dyslipidemia. Pretreatment visual acuity in the right eye was 0.03. And vitreous hemorrhage was present. After one ranibizumab intravitreal injection, the fundus became clearly visible. Macular subretinal hemorrhage and an RAM in the upper macula area were evident on FA and OCT. After four intravitreal injection of ranibizumab, macular hemorrhage resolved, RAM disappeared, and visual acuity improved to 0.2. All cases were treated by intravitreal injection of VEGF. After several injection, macular hemorrhage or macular edema resolved. RAM disappeared and visual acuity improved. Conclusion: Intravitreal injection of anti-VEGF appear effective for age-related macular degeneration or diabetic macular edema with concomitant RAM. Although anti-VEGF intravitreal injections are not covered by health insurance for the treatment of RAM, their effectiveness means that the expansion of indications is desirable.