Disappearance of soft drusen and subsequent development of choroidal neovascularization following macular hole surgery: a case report

Abstract

BackgroundDrusen are important risk factor for neovascular age-related macular degeneration (AMD) and have a dynamic nature as they can enlarge, newly form, or disappear over time. There have been few reports on drusen regression or choroidal neovascularization (CNV) development after macular hole surgery. We report, to our knowledge, the first case of both drusen regression and subsequent CNV development within 7 months of successful macular hole surgery.Case presentationA 73-year-old woman presented with a stage 3 full-thickness macular hole and large, confluent soft macular drusen in the right eye and a neovascular age-related macular degeneration (AMD) in the fellow eye. Four months after the successful macular hole surgery, significant regression of drusen was seen, especially in the temporal area to the fovea. Three months later, the patient developed CNV and her best-corrected visual acuity decreased to 20/100, despite further regression of macular drusen.ConclusionsMacular hole patients with macular soft drusen need to be carefully followed up after surgery for possible drusen regression and CNV development.

Vitrectomy with the inverted internal limiting membrane flap technique in eyes with full-thickness macular hole and dry age-related macular degeneration

“…20 Smiddy and coworkers reported nine eyes with CNV retrospectively selected from a group of 950 FTMH cases after surgery. 21 In PubMed Medline, only two cases of CNV formation after FTMH surgery were documented with OCT. 18,22 We observed CNV in one patient in the current group.…”

“…17 Conversely, several case reports presented disappearance of several drusen after vitrectomy for FTMH. 18 Holz and coworkers suggested that mechanical detachment of the posterior vitreous cortex might mechanically induce phagocytosis of drusen material. 19 We observed disappearance of drusen in two cases in the current group.…”

Choroidal neovascularisation following inverted internal limiting membrane flap technique for idiopathic macular hole: a case for modified flaps

“…CNVM has been reported previously after vitrectomy for FTMH 6–10. However, there are no reports following inverted ILM flap technique for the same.…”

“…This was followed by use of various other materials to stuff in the FTMH including human amniotic membrane, autologous lens capsule and autologous full thickness retinal grafts 4 5. Development of a choroidal neovascular membrane (CNVM) following macular hole surgery using the conventional approach of vitrectomy with ILM peeling has been reported in literature previously 6–10. However, none of the cases reported to date underwent surgery using the inverted ILM flap technique.…”

Efficacy of Vitrectomy and Macular Hole Repair in Eyes With Dry Age-Related Macular Degeneration

“…While prior works such as these are encouraging, other studies have shown a link between choroidal neovascularization and MH surgery. 6,7 Herein, we present our own retrospective evaluation of outcomes in patients with preexisting dAMD who underwent MH repair.…”