To compare the clinical features, multimodal imaging characteristics, and treatment outcomes of primary and secondary large retinal capillary aneurysms (LRCAs). A total of 34 eyes were included: seven with primary LRCA and 27 with secondary LRCA. All patients underwent fundus photography, optical coherence tomography (OCT), and fundus fluorescein angiography. Indocyanine green angiography and OCT-angiography were performed in selected cases. Various clinical, morphologic, and vascular features and treatment outcomes were evaluated and compared between the primary and secondary LRCA groups. All lesions in the primary LRCA group were unilateral, and five of seven were unifocal. However, in the secondary LRCA group, 19% of patients had bilateral involvement and lesions were multifocal in 48% of eyes. OCT characteristics, including the horizontal and vertical diameters of aneurysmal lesions and mean subfoveal choroidal thickness, were similar for the groups ( P > 0.05). During follow-up, neither visual acuity nor central macular thickness changed significantly in the primary LRCA group and no cases responded to treatment, whereas these improved significantly in the secondary LRCA group. Clinical and imaging characteristics of primary and secondary LRCA lesions were similar, although treatment outcomes were more favorable in secondary LRCA lesions because of the differing pathophysiology and etiology.

Retinal capillary macroaneurysms (RCM), a rare macular vascular disease, was reported here for the first time in a Chinese patient. A 68-year-old female patient presented with a complaint of blurred vision in her right eye for over a month. Upon specialized examination, her best-corrected visual acuity (BCVA) was 20/50 in the right eye. Fundus examination revealed yellow-white, hard exudates in the nasal and temporal sides of the fovea and a suspected hemorrhagic lesion was observed external to the inferior vascular arcade. Optical coherence tomography (OCT) scanning through the foveal center revealed a serous neurosensory detachment with intraretinal hard exudates. A preliminary diagnosis of chronic branch retinal vein occlusion (BRVO) in the right eye was made. To alleviate the macular serous detachment, the treatment plan was intravitreal injection of conbercept once a month. One month after the first injection, the patient reported worsening symptoms. BCVA in the right eye decreased to 20/100, and fundus examination revealed a ring-shaped yellow-white, fine, hard exudates surrounding the initial lesion. Two more intravitreal injections were given one month apart. Subsequently, intravitreal injections were discontinued due to inadequate therapeutic efficacy and considerations regarding treatment costs. Approximately 10 months after the last intravitreal injection, the patient reported improved vision. Optical coherence tomography angiography (OCTA) revealed a vertical oval tubular structure with a hyperreflective wall external to the inferior vascular arcade, with blood flow signals at the top of the lumen. Six more months later, the patient reported stable vision. OCTA still showed a vertical oval tubular structure, and the lumen diameter had increased. One more year later, the patient had a follow-up and the BCVA was 20/20 in both eyes. OCTA showed complete closure of the aneurysm without any abnormal blood flow. The right eye was conclusively diagnosed with RCM. This report presented the first documented Chinese case of isolated RCM. Although the lesion initially enlarged after three intravitreal injections of conbercept, it eventually resolved spontaneously. This outcome suggested that close observation may be appropriate for RCM patients with stable, good vision if such patients are unwilling or afraid to receive laser treatment.

The aim of this review was to summarize the most recent investigations on perifoveal exudative vascular anomalous complex (PEVAC) lesions and guide future research of this entity. Retrospective analysis of Cochrane Central, PubMed, Web of Science, and ClinicalTrials.gov databases for papers regarding PEVAC, looking for the following keywords: "perifoveal exudative anomalous vascular complex," "PEVAC," "PVAC," "nePVAC," "ePVAC," "deep retinal age-related microvascular anomalies," and "DRAMA." PEVACs are described as a single, massive, unilateral aneurysm that frequently present with intraretinal cystic edema surrounding the fovea, active exudation and hemorrhages, usually in healthy patients. Notwithstanding this, association with age-related macular degeneration, myopia, diabetes, lamellar hole, and pachychoroid pigment epitheliopathy are frequently reported. Currently, a multimodal imaging is warranted, especially the use of OCT and OCTA can rule out several other differential diagnoses. Because of the uncertainty of the pathophysiological mechanism, the right management of these lesions are yet to be clear. Overall, laser therapy has been effective in several reports, both with thermal and micropulse type. Anti-vascular endothelial growth factor injections and steroid injections demonstrated a nonconstant response. Several new findings are revolutionizing PEVAC management. Greater standardization could help understand the correct treatment of these lesions.

To report a case of a patient with perifoveal exudative vascular anomalous complex (PEVAC) and to analyze morphologic and vascular changes by optical coherence tomography (OCT) and OCT angiography (OCTA) before and after treatment. The authors reported a case that received multiple treatments for unresponsive effect to repeated aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. At last, the focal full-dose yellow laser was performed. A 57-year-old male patient presented with best-corrected visual acuity (BCVA) of 20/50 in his right eye (RE). The fundoscopic evaluation, structural OCT, and OCTA deposed for a diagnosis of PEVAC. The patient underwent three aflibercept intravitreal injections in the RE. Because no changes were detected, the authors opted for multiple sessions of yellow subthreshold micropulse laser therapy duty cycle 5%; however, no signs of regression were registered. Only after a full-dose yellow laser, signs of edema regression were observed. Structural OCT B-scan showed complete restoration of retinal profile, in the absence of any intraretinal or subretinal fluid and PEVAC lesion, whereas the OCTA showed a slight flow deficit at the previous lesion site. The PEVAC treatment is still unknown. In their experience, the authors reported a case of multiple treatments for unresponsive effect to aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. The focal full-dose yellow laser was the only effective treatment in this patient. The authors proposed the management to share the heterogeneous response at PEVAC entity.