Macular Hole Overlying Pigment Epithelial Detachment After Intravitreal Injection With Ranibizumab

Abstract

Macular hole formation after intravitreal injection with ranibizumab is a potential complication that should be considered before treatment, especially in those patients with large subfoveal pigment epithelial detachments and vitreomacular adhesion. Although successful closure may be attained after pars plana vitrectomy, this potential morbidity should be considered when treating these patients. In addition to the already well-described tractional forces of the vitreous overlying the fovea, and the potential contractile nature of a choroidal neovascular complex in response to ranibizumab, a posterior pushing or stretching mechanism of a large pigment epithelial detachment may also contribute to macular hole formation.

Full-thickness macular hole formation following anti-VEGF injections for neovascular age-related macular degeneration

“…FTMH formation following intravitreal anti-VEGF treatment for nAMD has been previously reported in the literature but was mainly based on isolated case reports 9–15. In all reported cases, vitreomacular interaction forces following intravitreal injections have been speculated to be closely linked to the formation of the MH.…”

“…Induction of vitreous incarceration following anti-VEGF injections could enhance vitreoretinal traction and subsequently FTMH development 13. Chemical compounds induced to the vitreous cavity and structural modification of vitreous body following anti-VEGF therapy could also lead to incomplete PVD, vitreomacular traction, and FTMH formation 14,15. Grigoropoulos et al hypothesized that intravitreal injections can increase the vitreomacular traction due to globe deformation during needle insertion and vitreous incarceration at the insertion site following treatment.…”

“…In addition, full-thickness macular hole (FTMH) formation following anti-VEGF treatment for nAMD has sparsely been reported in the literature, mainly as isolated case reports and mostly in the presence of vitreomacular traction disease 9–15. In light of the above, the purpose of this case series is to describe the development of FTMH in patients with nAMD, following anti-VEGF injections with variable therapeutic responses to treatment, even in the absence of pre-existing vitreomacular interface abnormalities.…”

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

“…The successful surgical treatment of MHs associated with PED was reported by Raiji et al . [7] and Cazabon,[8] but no report exists on closure of a PED-associated MH by intravitreal anti-VEGF treatment. However, the formation of MH during intravitreal VEGF treatment in patients with PED[1] and rip[2] is already described.…”

Vitreomakuläres Traktionssyndrom im Rahmen der Anti-VEGF-Therapie – 2 Kasuistiken

“…einer traktiven Makulopathieim Gegensatz zu unseren beiden Fällenbisher lediglich als Folge sekundärer Veränderungen oder Komplikationen durch die VEGF-Hemmung berichtet: Oshima und Mitarbeiter beschrieben die Bildung eines Makulaforamens als Folge eines Einrisses des retinalen Pigmentepithels und assoziierten dies mit der schnellen Kontraktion des retinalen Pigmentepithels als Nebeneffekt einer Anti-VEGF-Therapie [6]. Raiji et al beschrieben die Entstehung eines Makulaforamens nach einer einmaligen intravitrealen Therapie mit einem VEGF-Hemmer, jedoch hatte hier die vitreomakuläre Traktion bereits bestanden [7].…”