J Korean Ophthalmol Soc.  2013 Jul;54(7):1130-1134. 10.3341/jkos.2013.54.7.1130.

Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration

• Kim JM
• Jang JW
• Kyung SE
• Chang MH

• KMID: 2217428
• DOI: http://doi.org/10.3341/jkos.2013.54.7.1130

Abstract

PURPOSE
To report a case of a full-thickness macular hole after a single intravitreal injection of ranibizumab in a patient with choroidal neovascularization associated with age-related macular degeneration.
CASE SUMMARY
A 63-year-old woman presented to our department with gradually decreasing vision in her right eye. Best corrected visual acuity (BCVA) was measured as 0.7 in the right eye and 1.0 in the left eye. Examination of the macula showed a choroidal neovascularization associated with subretinal hemorrhage in the right eye. Optical coherence tomography (OCT) confirmed incomplete posterior vitreous detachment, subretinal hemorrhage and serous elevation. The patient subsequently received an intravitreal ranibizumab injection. After 1 month, the best corrected visual acuity in the right eye was decreased to 0.4, and fundus examination revealed posterior vitreous detachment and a macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-air exchange, SF6 gas injection, phacoemulsification and posterior chamber intraocular lens implantation. Three months later, the macular hole had closed completely and best visual acuity was 1.0.
CONCLUSIONS
Although the occurrence of a full-thickness macular hole after intravitreal ranibizumab injection is uncommon, physicians should be well acquainted with this complication.

Keyword

Intravitreal; Lucentis; Macular hole; Ranibizumab

MeSH Terms

Antibodies, Monoclonal, Humanized
Choroidal Neovascularization
Eye
Female
Hemorrhage
Humans
Intravitreal Injections
Lens Implantation, Intraocular
Macular Degeneration
Membranes
Phacoemulsification
Retinal Perforations
Tomography, Optical Coherence
Vision, Ocular
Visual Acuity
Vitrectomy
Vitreous Detachment
Ranibizumab
Antibodies, Monoclonal, Humanized

Figure

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  Figure 1. (A) A fundus photograph of right eye before an intravitreal ranibizumab injection shows a subretinal hemorrhage. (B) Fluorescein angiography shows hypofluorescence due to subretinal hemorrhage. (C) Optical coherence tomography reveals a mild vitremacular traction and serous elevation with subretinal hemorrhage.

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  Figure 2. (A) Fundus photograph 1 week later 1st intravireal ranibizumab injection showing macular hole. (B) OCT scan 1 week af-ter the intravitreal ranibizumab injection reveals persistence of vitreomacular traction at the foveola and anterior displacement of a small flap at the edge of macular hole. (C) OCT scan 4 weeks after intravitreal ranibizumab injection reveals complete posterior vit-reous detachment.

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  Figure 3. (A) Fundus photograph 3 month after the pars plana vitrectomy, the internal limiting membrane peeling, the fluid-air ex-change, the SF6 gas injection, phacoemulsification and posterior chamber intraocular lens implantation. (B) Optical coherence to-mograph shows that macular hole was closed completely.

Reference

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