J Korean Ophthalmol Soc.  2017 Jul;58(7):875-878. 10.3341/jkos.2017.58.7.875.

Full-thickness Macular Hole after Intravitreal Aflibercept Injection in a Patient with Wet Age-related Macular Degeneration

• Lee G
• Lee S

• KMID: 2387165
• DOI: http://doi.org/10.3341/jkos.2017.58.7.875

Abstract

PURPOSE
To report a case of full-thickness macular hole following intravitreal aflibercept injection in a patient with wet age-related macular degeneration (AMD).
CASE SUMMARY
A 70-year-old man presented to our department with gradually decreasing vision in his left eye. Best-corrected visual acuity was measured as 0.8 in the right eye and 0.2 in the left eye. Fundus examination, fluorescein angiography, and optical coherence tomography (OCT) showed occult choroidal neovascularization associated with subretinal fluid in the left eye. The patient received several intravitreal ranibizumab and bevacizumab injections in his left eye but responded poorly to the treatment. The patient was switched to intravitreal aflibercept injection. After 1 month, the best corrected visual acuity in the left eye was decreased to 0.05. Although the fundus examination was indistinct, OCT confirmed the presence of a full-thickness macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-gas exchange, 20% SF6 gas injection, phacoemulsification, and posterior chamber intraocular lens implantation. One month after the operation, the best corrected visual acuity was 0.2. The macular hole was closed completely, as confirmed by OCT.
CONCLUSIONS
Although the occurrence of a full-thickness macular hole after intravitreal aflibercept injection in the treatment of choroidal neovascularization with wet AMD is uncommon, physicians should pay attention for this complication.

Keyword

Aflibercept; Age-related macular degeneration; Macular hole

MeSH Terms

Aged
Bevacizumab
Choroidal Neovascularization
Fluorescein Angiography
Humans
Lens Implantation, Intraocular
Macular Degeneration*
Membranes
Phacoemulsification
Ranibizumab
Retinal Perforations*
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Vitrectomy
Bevacizumab
Ranibizumab

Figure

• 

  Figure 1 Fundus photography, fluorescein aniography (FA) and Optical coherence tomography (OCT). (A) Baseline fundus examination shows serous retinal detachment and some drusen. (B) Late phase FA shows occult choroidal neovascularization (CNV). (C) Baseline OCT shows type 1 CNV with subretinal fluid. (D) After treatment with 14 times intravitreal ranibizumab injections, OCT showed complete absorption of subretinal fluid. (E) This patient was treated with three intravitreal bevacizumab injections. OCT showed intraretinal fluid, increased retinal pigment epithelial detachment (RPED) and CNV. (F) Two weeks after the first intravitreal aflibercept injection, OCT showed a posterior viterous detachment, subretinal fluid, decrease of RPED and impending macular hole.

• 

  Figure 2 Optical coherence tomography (OCT). (A) One month after intravitreal aflibercept injection, OCT showed a full thickness macular hole. (B) One month after the vitrectomy, the internal limiting membrane peeling and the fluid-gas exchange, OCT showed that the macular hole was closed completely.

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