Macular Hole Surgery in the Case of Wet Age-Related Macular Degeneration Treated with Intravitreal Aflibercept

Abstract

A 72-year-old male treated with aflibercept (Eylea) due to choroidal neovascularization (CNV) in his left eye developed a full-thickness macular hole (MH) after the second injection. The occurrence of MH in his left eye resulted in further visual acuity deterioration. As a consequence of having developed the MH, the patient was operated on. Phacoemulsification and vitrectomy with internal limiting membrane peeling and 20% SF6 tamponade were performed. MH closure was achieved and best corrected visual acuity improved to the extent allowed by CNV. The patient continued anti-VEGF treatment with Eylea due to wet age-related macular degeneration in his left eye. The observation period of 2 years has been uneventful and visual acuity of 0.2 has remained stable.

Macular Hole Formation Following Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration

“…Until now, only a few cases describe FTMH formation as a cause of visual decrease after intravitreal injection of anti-VEGF agents for neovascular AMD, like ranibizumab (sixteen cases) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] and bevacizumab (two cases) [ 14 , 15 ]. Eight cases were reported after aflibercept intravitreal injection [ 10 , 16 , 17 , 18 , 19 , 20 ].…”

“…Although anti-VEGF therapy is an effective treatment for MNV and macular edema in neovascular AMD, myopic choroidal neovascularization, polypoidal choroidal vasculopathy, retinal vein occlusion, etc., a limited number of ocular adverse events including endophthalmitis, increased intraocular pressure, retinal tear or detachment, retinal pigment epithelium tear, retinal ischemia, traumatic cataract, uveitis, and vitreous hemorrhage have been reported [ 2 ]. Full-thickness macular hole (FTMH) formation following intravitreal injections is rare and has only been reported in a few case reports and case series, mostly in association with neovascular AMD and in the presence of vitreomacular traction (VMT) disease [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Herein, we present a patient who developed a FTMH following intravitreal aflibercept injections for the treatment of MNV associated with AMD.…”

Full-Thickness Macular Hole in Age-Related Macular Degeneration Patients With Two Distinct Entities

“…Tractional FTMHs may form by tangential or anteroposterior vitreous traction, ERM, PED, or changes in the CNV membrane. 9,10,25 Although degenerative FTMHs may be caused by atrophic process of the retina secondary to collapsed PED or macular scarring, 8 Cohen et al described retinal pseudocysts in a subset of eyes presenting with geographic atrophy. It was corresponded to optically empty spaces, frequently located in the inner nuclear layer, and they suggested that pseudocysts might correspond to Müller cell degeneration.…”

“…The pathogenesis might be tractional from anteroposterior or tangential vitreomacular traction with or without CNV contraction or degenerative which results from a atrophic processes in the underlying choroid and malfunctioning RPE. [8][9][10] Anti-vascular endothelial growth factor intravitreal injections can also induce vitreoretinal traction leading to the development of a FTMH or anti-vascular endothelial growth factor itself can modulate the activity of CNV and induce contraction of the membrane which may result in FTMHs. [11][12][13] For FTMHs in the presence of AMD, success rates for anatomical closure after pars plana vitrectomy range between 75% and 89% 11,14,15 and considered significantly lower in comparison with idiopathic FTMHs with anatomical success rates of above 90%.…”

Unexpected Vision Loss following Six Intravitreal Injections for Neovascular Age-Related Macular Degeneration

“…Epidemiological studies have shown that postmenopausal women have greater incidence of FTMHs, presumably due to decreases in estrogen leading to vitreous contraction [4]. To our knowledge, only 9 cases of FTMH formation after intravitreal aflibercept injection have been reported [5][6][7][8][9][10][11]. Multiple studies have delineated the capability of optical coherence tomography (OCT) in accurately diagnosing retinal pathologies such as PVD [12], subretinal hemorrhage [13], outer retinal hyperreflective deposits [14], and optic disk pit maculopathy [15].…”