Removal of choroidal neovascular membrane in a case of macular hole after anti-VEGF therapy for age-related macular degeneration

Hirata, Akira; Hayashi, Ken; Murata, Kazuhisa; Nakamura, Kei‐ichiro

doi:10.1016/j.ajoc.2017.12.003

Cited by 13 publications

(12 citation statements)

References 15 publications

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“…3 B and C). 6 The surgery was completed by performing fluid-air exchange in the vitreous cavity and then replacing with silicone oil. The patient was instructed to maintain a prone position for three days.…”

Section: Case Reportmentioning

confidence: 99%

Macular pucker formation after macular hole surgery with inverted internal limiting membrane flap technique and silicone oil tamponade

Hirata

Takano

Kawaji

et al. 2020

American Journal of Ophthalmology Case Reports

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Purpose The inverted internal limiting membrane (ILM) technique was recently introduced for refractory macular hole. Here, we evaluate a case of macular pucker formation after macular hole surgery using the inverted ILM flap technique and silicone oil tamponade. After undergoing vitrectomy combined with ILM removal, the patient had a good visual prognosis. Observations A 49-year-old male with macular hole affecting both of his eyes underwent vitrectomies. Three months after the first surgery in his right eye, macular pucker formation was observed in the macula, which was associated with the ILM flap used to cover the macular hole. After peeling the ILM, the macula returned to a normal contour and visual acuity improved. Examination of the removed ILM revealed macrophage-like cells containing silicone oil particles that were responsible for the ILM contraction. Conclusions and Importance When using the inverted ILM flap technique and silicone oil, macular pucker may occur after macular hole surgery. Peeling of the ILM flap restored the macular shape and did not reopen the macular hole, thereby improving visual acuity. Thus, silicone oil should be used with caution when performing macular hole surgery with the ILM flap technique.

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Section: Case Reportmentioning

confidence: 99%

Macular pucker formation after macular hole surgery with inverted internal limiting membrane flap technique and silicone oil tamponade

Hirata

Takano

Kawaji

et al. 2020

American Journal of Ophthalmology Case Reports

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“…More recently, Hirata et al reported the removal of a CNV-membrane with 25-gauge instruments through the coincident presence of a macular hole after anti-VEGF therapy for AMD and observed a rapid resolution of the intraretinal macular oedema with a fast anatomical and functional recovery to 20/40. 16 …”

Section: Discussionmentioning

confidence: 99%

Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Meyer¹,

Kammann²,

Meyer³

2021

American Journal of Ophthalmology Case Reports

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Purpose To present the surgical treatment of a full thickness macular hole (MH) caused by a vitreomacular traction (VMT) on top of an adjacent subfoveal pigment epithelial detachment (PED) in age-related macular degeneration (AMD). Observation A 77-year-old female with a subfoveal PED receiving consecutive intravitreal injections noticed a sudden decreased visual acuity (VA) due to the development an occult MH in her right eye after 19 repeated intravitreal anti vascular endothelial growth factor (VEGF)-injections. Her initial VA declined from 20/50 to 20/400. The firm VMT induced a rupture of the multi-layered retina and may progress to an RPE-tear or possible to a subretinal haemorrhage. We discussed with the patient the risks of the natural progression and explained possible treatment options: We continued her anti-VEGF combined with air bubble injections to induce a posterior vitreous detachment, to stabilise the retinal architecture, reduce the subretinal fluid and avoid possible intraoperative bleeding. As injections did release the VMT, vitrectomy released the posterior vitreous from the optic nerve and trimmed it towards the central retina. Peeling with brilliant blue removed the internal limiting membrane without any signs of bleeding, rupture of the PED or enlargement of the MH, prior to the installation of 10% SF6 gas. The postoperative optical coherence tomography (OCT) on day 5 confirmed a closed MH, while the size, shape and pattern of the PED remained unchanged. Her VA increased from 20/400 to 20/50 (equal to her previous VA prior to the MH-formation). To avoid a potential progression of the PED, we maintained her retreatment intervals at 5 weeks for the next 6 months. A literature review presents similar intraoperative approaches and postoperative outcomes in 8 out of the 9 published cases. Conclusions and importance VMT can induce an occult MH on top of a PED, causing a significant loss of vision. When gas injections are not successful, surgery may release the traction, restore the retinal architecture, and significantly improve and maintain the VA over a documented long-term observation. The epiretinal procedure should be assisted under regular anti-VEGF injections to maintain the subretinal architecture.

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“…On the other hand, several pathogenic mechanisms have been involved in the formation of MH in AMD [4][5][6][7][8]:…”

Section: Discussionmentioning

confidence: 99%

Simultaneous retinal pigment epithelium tear and lamellar macular hole evolving to a full-thickness macular hole after intravitreal injection

Moll‐Udina

Alforja-Castiella

Figueroa-Vercellino

et al. 2020

Journal Français d'Ophtalmologie

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Removal of choroidal neovascular membrane in a case of macular hole after anti-VEGF therapy for age-related macular degeneration

Cited by 13 publications

References 15 publications

Macular pucker formation after macular hole surgery with inverted internal limiting membrane flap technique and silicone oil tamponade

Macular pucker formation after macular hole surgery with inverted internal limiting membrane flap technique and silicone oil tamponade

Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature

Simultaneous retinal pigment epithelium tear and lamellar macular hole evolving to a full-thickness macular hole after intravitreal injection

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