Most RAM Cases Will Improve Spontaneously

Nearly one-third of eyes with RAM underwent treatment within two weeks of presentation, with the majority treated with anti-VEGF monotherapy or combination therapy. Photo: Angela Diamantakos, OD. Click image to enlarge. Although rare, retinal arterial macroaneurysms (RAMs) have severe clinical implications. They are unique in their ability to cause subretinal, intraretinal, sub-ILM, subhyaloid and vitreous hemorrhage. Currently, there are no standard treatment guidelines for them. Proposed management options include observation, laser photocoagulation, anti-VEGF therapy and surgery. RAMs are considered self-healing, so nonsurgical management is often considered the preferred treatment, as it does not have technical limitations. Researchers based out of the Bascom Palmer Eye Institute in Miami decided to compare the long-term outcomes of patients with RAM initially managed with observation compared to those undergoing early treatment. While anti-VEGF injections were the most commonly performed procedure for RAM management, most eyes diagnosed with RAM were actually observed and did not initially undergo treatment. Treatment was instead performed more frequently in eyes that were, on average, presenting with worse best-corrected visual acuity (BCVA) and had macula-involving hemorrhage.The study cohort included 156 adult patients (161 eyes) diagnosed with RAM at Bascom Palmer Eye Institute over an almost 12-year period. The mean age was 73.7 years, and 67% were women. Hypertension was present in 81% of patients.A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years, and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 68% of eyes were managed with observation, and 32% were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50) and more frequently reported macula-involving hemorrhage (78% vs. 52%) 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 anti-VEGF 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). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days).“While these findings may suggest that eyes with greater disease burden could benefit from anti-VEGF therapy, a direct relationship cannot be determined,” the researchers did note in their paper, which was published in Ophthalmology Retina. “Although anatomic resolution does not directly equate to visual outcomes, it may correlate with earlier visual improvement.”Though they initially presented with worse BCVA and a higher prevalence of macula-involving hemorrhage, treated eyes had a more rapid time to resolution.“This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously,” the study concluded. “However, selective treatment of eyes with more severe initial presentation may be beneficial.”Click here for the journal source. Zhang C, Bowers KE, Khan S, et al. Retinal arterial macroaneurysms: clinical features, management and outcomes. Ophthlamol Retina. June 5, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.