Título

Late Choroidal Neovascularization After Uneventful Macular Hole Closure Surgery

Introdução / Purpose

Choroidal neovascularization is an uncommon condition which can occur after macular peeling, related to traumatic EPR/choriocapillaris damage during the procedure1. We intend to demonstrate that neovascularization can also occur secondary to EPR/choriocapillaris atrophy itself, presenting a well documented case report.

Material e Método / Methods

Case report.

Resultados / Results

A 78-year-old female had blurred vision caused by a lamellar hole. Eighteen months later, a full macular hole (fig 1, 2, 3) developed, with marked visual acuity decrease.
We performed vitreoretinal intervention, with vitrectomy, internal limiting membrane peeling, SF6 injection and face-down positioning. The procedure was done uneventfully and one week later, the macular hole was closed (fig 4, 5).
Postoperatively, a small area of atrophy could be seen in the center of the macula, but the affected area clearly grew in diameter, in following months (fig 6, 7, 8).
In the sixth year of postsurgical follow up, the patient noticed metamorphopsia. Optical coherence tomography (OCT) and angiography evidenced choroidal neovascularization (fig 9, 10, 11), whose wasn’t present in the previous examination, 6 months earlier (fig 8).

Discussão e Conclusões / Discussion

According to Tang & Shakin2, most of the CNVs develops in the site of surgical manipulation, in which EPR disrupture appears as window defect dots. In this case, we have angiographies, which suggest no significant EPR trauma secondary to surgical maneuvers. So that, the CNV probably developed secondary to retinochoroidal atrophy in the central region of the macula, as in geographic atrophy secondary to age-related macular degeneration.

Palavras Chave

Vitrectomy, choroidal neovascularization, late, macular hole