Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment

Abstract

We describe a case of macular hole (MH) closure after intravitreal bevacizumab therapy for an underlying pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD). The 73-year-old Caucasian female presented with reduced visual acuity (20/80) of the left eye and metamorphopsia for approximately 6 months. Spectral domain optical coherence tomography revealed a subfoveal PED due to AMD with an associated MH. To treat the exudative component of the pathology, we started intravitreal bevacizumab therapy, consecutively leading to reduction of the height of PED and allowing closure of the MH. Detachment recurred during further follow-up, but the MH remained closed. MHs and exudative AMD are common diseases, which rarely occur simultaneously. To the best of our knowledge (search via PubMed for “MH,” “PED,” “age-related macular degeneration”), no other case with the persistent closure of an MH associated with PED during intravitreal antivascular endothelial growth factor therapy and despite recurrent PED has been published to date.

Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”

“…The role of anti-vascular endothelial growth factor (anti-VEGF) agents in serous PED without subretinal or intraretinal fluid or active choroidal neovascular membrane/idiopathic polypoidal choroidal vasculopathy may require further research. In the present case,[ 1 ] the shallow subretinal fluid at one margin of the macular hole could have been related to the macular hole itself or the mechanical effect of the high PED. In such a scenario, fundus fluorescein angiogram and indocyanine green angiogram would add significant scientific value and justification for the use of bevacizumab in this case, if they are available.…”

“…I read with interest the case report on the closure of a macular hole over a serous retinal pigment epithelial detachment (PED) with intravitreal bevacizumab. [ 1 ] I want to humbly discuss a few facts.…”

“…The rare but potentially blinding complications of intravitreal anti-VEGF agents such as endophthalmitis[ 3 ] and retinal detachment should be kept in mind. The goal of management with intravitreal bevacizumab in the presented case[ 1 ] may need elucidation. A history of systemic or local steroid use is also relevant in the presented case, as central serous chorioretinopathy, though unlikely in a 73 year old, needs to be ruled out.…”

Response to comment on “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”

“…[ 1 ] Fluorescein angiography (FAG) is indeed helpful in the diagnosis of exsudative age-related macular degeneration, but in our opinion, FAG would not provide additional information about the point of interest which is the pathomechanism of either coexisting or secondarily developed macular hole. [ 2 ] In fact, bevacizumab was chosen instead of the approved intravitreal vascular endothelial growth factor (VEGF) inhibitors since besides the retinal pigment epithelial detachment (PED), there was no intra- or sub-retinal fluid and thus no in-label indication was present at that time. Bevacizumab was therefore chosen as an off-label therapeutic attempt which at that time was affordable by the patient.…”

“…We explicitly emphasize that the patient presented here was treated with an off-label medication and that an extensive informed consent was undertaken before therapy. [ 2 ] Best regards.…”