Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration

Min Kim Jong; Won Jang Jun; Eun Kyung Sung; Hwan Chang Moo

doi:10.3341/jkos.2013.54.7.1130

Journal List > J Korean Ophthalmol Soc > v.54(7) > 1009434

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Jong, Jun, Sung, and Moo: Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2013;54(7):1130-1134.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1130

Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration

Min Kim Jong, MD, Won Jang Jun, MD, Eun Kyung Sung, MD, PhD, Hwan Chang Moo, MD, PhD

¹Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea

Address reprint requests to Moo Hwan Chang, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea Tel: 82-41-550-6497, Fax: 82-41-561-0137 E-mail: changmh@dankook.ac.kr

* This study was presented as a e-poster at the 108th Annual Meeting of the Korean Ophthalmology Society 2012.

Received 20 October 201225 February 2013 Accepted 13 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of a full-thickness macular hole after a single intravitreal injection of ranibizumab in a patient with choroidal neovascularization associated with age-related macular degeneration.

Case summary

A 63-year-old woman presented to our department with gradually decreasing vision in her right eye. Best corrected visual acuity (BCVA) was measured as 0.7 in the right eye and 1.0 in the left eye. Examination of the macula showed a choroidal neovascularization associated with subretinal hemorrhage in the right eye. Optical coherence tomog-raphy (OCT) confirmed incomplete posterior vitreous detachment, subretinal hemorrhage and serous elevation. The pa-tient subsequently received an intravitreal ranibizumab injection. After 1 month, the best corrected visual acuity in the right eye was decreased to 0.4, and fundus examination revealed posterior vitreous detachment and a macular hole. The pa-tient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-air exchange, SF6 gas injection, phacoemulsification and posterior chamber intraocular lens implantation. Three months later, the macular hole had closed completely and best visual acuity was 1.0.

Conclusions

Although the occurrence of a full-thickness macular hole after intravitreal ranibizumab injection is un-common, physicians should be well acquainted with this complication.

Keywords: Intravitreal, Lucentis, Macular hole, Ranibizumab

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Figure 1.

(A) A fundus photograph of right eye before an intravitreal ranibizumab injection shows a subretinal hemorrhage. (B) Fluorescein angiography shows hypofluorescence due to subretinal hemorrhage. (C) Optical coherence tomography reveals a mild vitremacular traction and serous elevation with subretinal hemorrhage.

Figure 2.

(A) Fundus photograph 1 week later 1st intravireal ranibizumab injection showing macular hole. (B) OCT scan 1 week af-ter the intravitreal ranibizumab injection reveals persistence of vitreomacular traction at the foveola and anterior displacement of a small flap at the edge of macular hole. (C) OCT scan 4 weeks after intravitreal ranibizumab injection reveals complete posterior vit-reous detachment.

Figure 3.

(A) Fundus photograph 3 month after the pars plana vitrectomy, the internal limiting membrane peeling, the fluid-air ex-change, the SF6 gas injection, phacoemulsification and posterior chamber intraocular lens implantation. (B) Optical coherence to-mograph shows that macular hole was closed completely.

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