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Lee and Lee: Full-thickness Macular Hole after Intravitreal Aflibercept Injection in a Patient with Wet Age-related Macular Degeneration
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(7): 875-878.

Published online: 14 July 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.875

Full-thickness Macular Hole after Intravitreal Aflibercept Injection in a Patient with Wet Age-related Macular Degeneration

Gwonhwee Lee, MD, Seungwoo Lee, MD

Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea.

Address reprint requests to Seungwoo Lee, MD. Department of Ophthalmology, Dongguk University Gyeongju Hospital, #87 Dongdae-ro, Gyeongju 38067, Korea. Tel: 82-54-770-8256, Fax: 82-54-772-9618, jazzhanul@hanmail.net

Received 27 April 2017       Revised 11 June 2017       Accepted 26 June 2017

©2017 The Korean Ophthalmological Society

(open-access):

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 full-thickness macular hole following intravitreal aflibercept injection in a patient with wet age-related macular degeneration (AMD).

Case summary

A 70-year-old man presented to our department with gradually decreasing vision in his left eye. Best-corrected visual acuity was measured as 0.8 in the right eye and 0.2 in the left eye. Fundus examination, fluorescein angiography, and optical coherence tomography (OCT) showed occult choroidal neovascularization associated with subretinal fluid in the left eye. The patient received several intravitreal ranibizumab and bevacizumab injections in his left eye but responded poorly to the treatment. The patient was switched to intravitreal aflibercept injection. After 1 month, the best corrected visual acuity in the left eye was decreased to 0.05. Although the fundus examination was indistinct, OCT confirmed the presence of a full-thickness macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-gas exchange, 20% SF6 gas injection, phacoemulsification, and posterior chamber intraocular lens implantation. One month after the operation, the best corrected visual acuity was 0.2. The macular hole was closed completely, as confirmed by OCT.

Conclusions

Although the occurrence of a full-thickness macular hole after intravitreal aflibercept injection in the treatment of choroidal neovascularization with wet AMD is uncommon, physicians should pay attention for this complication.

Keywords: Aflibercept, Age-related macular degeneration, Macular hole

Figures and Tables

Figure 1

Fundus photography, fluorescein aniography (FA) and Optical coherence tomography (OCT). (A) Baseline fundus examination shows serous retinal detachment and some drusen. (B) Late phase FA shows occult choroidal neovascularization (CNV). (C) Baseline OCT shows type 1 CNV with subretinal fluid. (D) After treatment with 14 times intravitreal ranibizumab injections, OCT showed complete absorption of subretinal fluid. (E) This patient was treated with three intravitreal bevacizumab injections. OCT showed intraretinal fluid, increased retinal pigment epithelial detachment (RPED) and CNV. (F) Two weeks after the first intravitreal aflibercept injection, OCT showed a posterior viterous detachment, subretinal fluid, decrease of RPED and impending macular hole.

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Figure 2

Optical coherence tomography (OCT). (A) One month after intravitreal aflibercept injection, OCT showed a full thickness macular hole. (B) One month after the vitrectomy, the internal limiting membrane peeling and the fluid-gas exchange, OCT showed that the macular hole was closed completely.

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Notes

Conflicts of Interest The authors have no conflicts to disclose.

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