Título

MACULAR HOLE DEVELOPMENT AFTER INTRAVITREAL ANTIANGIOGENIC INJECTION

Objetivo

Describe the case and surgical follow-up of a patient undergoing antiantiogenic treatment for neovascular subretinal membrane who developed a macular hole after the use of anti-VEGF.

Métodos

Case report

Resultados

61-year old female diagnosed with type 1 macular neovascularization (MNV) in the left eye (OS) was referred to specific treatment.
Best corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/60 in the OS.
Fundus near infrared (NIR) imaging and optical coherence tomography (OCT) showed subretinal and intraretinal fluid; type 1 MNV and flat detachment of retinal pigment epithelium (PED). Proceeded to treatment managed initially with monthly intravitreal ranibizumab.
After 3 months of treatment there was no response which led to the decision of switching medication for aflibercept. Patient was submitted to a new cycle of 3 monthly injections, followed by treat and extend protocol. As a result, an anatomic and functional improvement was obtained, with BCVA of 20/30 and OCT displayed absence of subretinal fluid and a partial posterior vitreous detachment (PVD).
After 5 years of follow-up, patient came up with a sudden VA decrease (20/400) in OS. Fundoscopy exhibited retinal pigment epithelium alteration inferior to the macula and a visible hole appearance. NIR and OCT displayed a total PVD and full-thickness MH.
Prior to surgical procedures, one aflibercept application was performed. 10 days later, patient was submitted to phacoemulsification with intraocular lens implantation, pars plana vitrectomy and internal limiting membrane peeling.
1 month after surgery BCVA was 20/200 although an anatomic success of MH closure was evident.

Discussão e Conclusões

MH formation after anti-VEGF therapy is poorly described on literature and occurs mainly when previous PED is present, caused by new onset of macular hemorrhage or RPE rupture. Partial PVD is also considered a risk factor, as well as the presence of epiretinal membrane in which anteroposterior forces appear to lead to it's contraction.

Palavras Chave

MACULAR HOLE, ANTIANGIOGENIC, THERAPY

Área

Cirúrgica