Bilateral Macular Hole After Anti–vascular Endothelial Growth Factor Therapy in a Patient With Exudative Age-Related Macular Degeneration

Regatieri, Caio V.; Duker, Jay S.

doi:10.1097/icb.0b013e3182160952

Cited by 10 publications

(11 citation statements)

References 10 publications

(13 reference statements)

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“…Our findings correlate with most of the published cases 7 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 : most surgeons determined a small MH on the preoperative OCT, with frequent signs of ERM or VMT, undermining vitreous tractions as a causative factor. They also predominantly performed a PPV with a consecutive ILM-peel and gas tamponade.…”

Section: Discussionsupporting

confidence: 89%

“… 2018 33 77-years, male OD, RPE-tear IVR phaco, 25g ppv, ILM peeling, 16% C3F8 na na 7 Raiji VR, Eliott D, Sadda SR. 2013 34 69-years, female OS, VMT, PED IVR 20/200 20/60 IV ppv, ILM peeling, gas no hem 8 Regatieri CV, Ducker JS. 2012 35 76-years, male OD, VMT, CNV 1x IVR not improved ppv, ILM peeling, gas open no hem 9 Clemens C, Holz FG, Meyer CH. 2010 7 67-years, female OS, VMT, PED 3x IVR 20/30 20/30 III 23g ppv, ILM peeling, 20% SF6 closed, no hem foveal lucency 12 10 Meyer PS, Kammann MT, Meyer CH.…”

Section: Discussionmentioning

confidence: 99%

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Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Meyer¹,

Kammann²,

Meyer³

2021

American Journal of Ophthalmology Case Reports

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Purpose To present the surgical treatment of a full thickness macular hole (MH) caused by a vitreomacular traction (VMT) on top of an adjacent subfoveal pigment epithelial detachment (PED) in age-related macular degeneration (AMD). Observation A 77-year-old female with a subfoveal PED receiving consecutive intravitreal injections noticed a sudden decreased visual acuity (VA) due to the development an occult MH in her right eye after 19 repeated intravitreal anti vascular endothelial growth factor (VEGF)-injections. Her initial VA declined from 20/50 to 20/400. The firm VMT induced a rupture of the multi-layered retina and may progress to an RPE-tear or possible to a subretinal haemorrhage. We discussed with the patient the risks of the natural progression and explained possible treatment options: We continued her anti-VEGF combined with air bubble injections to induce a posterior vitreous detachment, to stabilise the retinal architecture, reduce the subretinal fluid and avoid possible intraoperative bleeding. As injections did release the VMT, vitrectomy released the posterior vitreous from the optic nerve and trimmed it towards the central retina. Peeling with brilliant blue removed the internal limiting membrane without any signs of bleeding, rupture of the PED or enlargement of the MH, prior to the installation of 10% SF6 gas. The postoperative optical coherence tomography (OCT) on day 5 confirmed a closed MH, while the size, shape and pattern of the PED remained unchanged. Her VA increased from 20/400 to 20/50 (equal to her previous VA prior to the MH-formation). To avoid a potential progression of the PED, we maintained her retreatment intervals at 5 weeks for the next 6 months. A literature review presents similar intraoperative approaches and postoperative outcomes in 8 out of the 9 published cases. Conclusions and importance VMT can induce an occult MH on top of a PED, causing a significant loss of vision. When gas injections are not successful, surgery may release the traction, restore the retinal architecture, and significantly improve and maintain the VA over a documented long-term observation. The epiretinal procedure should be assisted under regular anti-VEGF injections to maintain the subretinal architecture.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Meyer¹,

Kammann²,

Meyer³

2021

American Journal of Ophthalmology Case Reports

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“…MH is a rare yet sight threating complication of intravitreal anti-VEGF agent injection [3–13]. Our literature research based on Pubmed database revealed that there were only dozens of cases who developed a full thickness MH after intravitreal injection of anti-VEGF angents which were mostly involved with ranibizumab and bevacizumab, and occasionally with aflibercept [3–15].…”

Section: Discussionmentioning

confidence: 99%

“…Although MH formation after intravitreal anti-VEGF agent injection is quite rare, it should be kept in mind that such complication might occur after intravitreal injection of any anti-VEGF agent. CNV Patients should be warned about this potential complication, and it should also be included in the differential diagnosis when CNV lesions did not show any therapic response to or even deteriorated after anti-VEGF agent therapy [4, 5, 13, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, intravitreal anti-vascular endothelial growth factor (VEGF) agents have successfully improved the treatment outcome and visual prognosis of CNV. However, macular hole (MH) formation has emerged to be a new challenging adverse effect of intravitreal anti-VEGF agent therapy for CNV, which was mostly reported in anti-VEGF therapy for exudative AMD cases [3–13].…”

Section: Introductionmentioning

confidence: 99%

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Macular hole retinal detachment after intravitreal Conbercept injection for the treatment of choroidal neovascularization secondary to degenerative myopia: a case report

et al. 2019

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Background We report a case of macular hole (MH) formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization (CNV) secondary to degenerative myopia. Case presentation A 60-year-old woman presented with blurred vision in her left eye was diagnosed as CNV secondary to degenerative myopia. Intravitreal injection of conbercept, an anti -vascular endothelial growth factor (VEGF) agent, was uneventfully performed in the left eye. Unfortunately, a full thickness MH and retinal detachment was found three weeks postoperatively by ophthalmoscopy and spectral-domain optical coherence tomography. Vitrectomy, internal limiting membrane peeling and silicone oil tamponade were then performed, and macular retina was reattached soon after surgery. However, MH still kept open during three months’ follow-up. Conclusion MH is a quite rare complication of intravitreal anti- VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.

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Simultaneous development of full-thickness macular hole and neovascular age-related macular degeneration

Aoki

Imaizumi

2022

American Journal of Ophthalmology Case Reports

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Purpose To present a case of full-thickness macular hole (MH) with treatment-naïve neovascular age-related macular degeneration (nAMD). Observations A 74-year-old woman presented with sudden visual impairment and floaters in her left eye. Fundus examination revealed retinal hemorrhages and hemorrhagic pigment epithelial detachment at the fovea. Optical coherence tomography angiography revealed both type 1 nAMD and stage 4 MH obscured by blood. After the first intravitreal aflibercept injection, early pars plana vitrectomy in addition to the inverted internal limiting membrane flap technique was performed to close MH without complications. This improved the patient's visual acuity. Throughout the postoperative follow-up period of 18 months, recurrent exudates from nAMD required repetitive aflibercept injections; MH relapse was not observed. Conclusions MH can be complicated by acute, treatment-naïve nAMD. Early surgical closure of secondary MH combined with anti-vascular endothelial growth factor therapy for nAMD may yield a satisfactory visual outcome.

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Bilateral Macular Hole After Anti–vascular Endothelial Growth Factor Therapy in a Patient With Exudative Age-Related Macular Degeneration

Abstract: Exudative age-related macular degeneration can be a precursor to macular hole formation.

Cited by 10 publications

References 10 publications

Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Macular hole retinal detachment after intravitreal Conbercept injection for the treatment of choroidal neovascularization secondary to degenerative myopia: a case report

Simultaneous development of full-thickness macular hole and neovascular age-related macular degeneration

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