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leber 's miliary aneurysm is a variant of coats disease and similar to type 1 idiopathic macular telangiectasia .
a recent report showed that an intravitreal injection of bevacizumab ( ivb ) was effective in an adult patient with type 1 idiopathic macular telangiectasia .
we describe our experience with an adult patient with a macular edema caused by leber 's miliary aneurysm , which had not been resolved by prior retinal laser photocoagulation , who underwent ivb .
we investigated the ocular characteristics of the patient before and after a single administration of ivb .
the macular edema had partially improved 1 month after ivb , but then it worsened .
leber 's miliary aneurysm is a variant of coats disease and similar to type 1 idiopathic macular telangiectasia ( imt ) .
.   reported on an adult case of type 1 imt that had remarkably improved by an intravitreal injection of bevacizumab ( ivb ) .
lin et al .   also concluded that ivb was a well - tolerated treatment for children with coats disease ; in all 3 patients in their study , the subretinal fluid was completely reabsorbed after they received ivb .
we hypothesized that ivb would also be effective in the treatment of a macular edema caused by leber 's miliary aneurysm ; therefore , we administered this treatment to an adult patient with this condition . to the best of our knowledge , this case is the first report of ivb to treat a macular edema caused by leber 's miliary aneurysm .
a 60-year - old healthy male visited our hospital because he was found to have low visual acuity in his left eye at an examination to renew his driver 's license . on his first visit , his best corrected visual acuity ( bcva ) was 1.0 and 0.5 for his right and left eye , respectively . in his left eye , at 6 to 9 o'clock of the retina , we found aneurysms , widespread exudative lesions , serous retinal detachment , dilated vessels , and retinal hemorrhages .
focal exudative lesions with hard exudates and retinal hemorrhages were found at 1 and 4 o'clock of the mid - peripheral retina .
a macular edema , hard exudates , and some aneurysms were found in the posterior pole .
fluorescein angiography revealed many aneurysms with leakage at 6 to 9 o'clock of the retina , at 1 and 4 o'clock of the mid - peripheral retina , and near the macula ( fig .
1a ) . optical coherence tomography showed a moderate cystoid macular edema and subretinal fluid ( fig .
no particular lesions were found in the right eye . based on these findings , we diagnosed the patient with leber 's miliary aneurysm .
although we assumed that the macular edema was caused by the aneurysms near the fovea , we did not perform laser photocoagulation so as not to injure the macula by this initial treatment . as there was no change in the macular edema or bcva , ivb ( 1.25 mg of bevacizumab ) was administered 1 month after laser photocoagulation , after informed consent was obtained from the patient .
the retinal thickness in the macular region was comparatively decreased 1 month after ivb ( fig .
serous retinal detachment found at 6 to 9 o'clock of the peripheral retina had improved .
six months after ivb , the macular edema became more severe than it had been before ivb ( fig .
the patient did not want to undergo a second administration of ivb , because he felt that there had not been sufficient improvement after the first administration of ivb . to treat the continuing macular edema , we performed laser photocoagulation of the aneurysms near the fovea .
treatment with ivb for type 1 imt , the pathological mechanism of which is similar to leber 's miliary aneurysm , has been reported ; but to the best of our knowledge , treatment with ivb for leber 's miliary aneurysm has not been described previously .
reported a case of type 1 imt in whom a single administration of ivb was remarkably effective .
and matsumoto and yuzawa   reported that ivb had limited efficacy for type 1 imt ; the courses of their studies resemble our case .
these were all small case series , and further investigations are necessary to determine the efficacy of ivb for this type of aneurysm . in our patient , the effect of ivb on leber 's miliary aneurysm was limited .
although there was no improvement in the patient 's bcva following the treatment with ivb , there are some points that merit discussion .
first , the precise duration of the disease , especially the onset of the macular edema , was unclear ; the duration of the edema is sometimes critical for a successful treatment with ivb .
our patient 's retinal thickness transiently decreased after ivb , but his bcva did not improve .
it is possible that treatment with ivb might have increased the bcva in a patient in whom the disease onset was more recent .
second , ivb was administered only once in this case , but repeated ivb might have improved the bcva , as we have often experienced in patients with macular lesions due to age - related macular degeneration and retinal vein occlusion .
the pathological mechanism of leber 's miliary aneurysm is similar to coats disease and type 1 imt .
laser photocoagulation that is generally used as a treatment for coats disease and type 1 imt appeared also effective for leber 's miliary aneurysm in our case .
the authors have no proprietary interests nor grants and funds received in support of this study to declare .
purposeleber 's miliary aneurysm is a variant of coats disease and similar to type 1 idiopathic macular telangiectasia . 
 a recent report showed that an intravitreal injection of bevacizumab ( ivb ) was effective in an adult patient with type 1 idiopathic macular telangiectasia . 
 we describe our experience with an adult patient with a macular edema caused by leber 's miliary aneurysm , which had not been resolved by prior retinal laser photocoagulation , who underwent ivb.methodswe investigated the ocular characteristics of the patient before and after a single administration of ivb.resultsthe macular edema had partially improved 1 month after ivb , but then it worsened . 
 we performed laser photocoagulation to treat the aneurysms near the fovea . 
 the macular edema improved , but there was no improvement in visual acuity.conclusionin this patient , the effect of ivb was limited .