Macular Hole Formation in the Presence of a Pigment Epithelial Detachment After Three Consecutive Intravitreal Antivascular Endothelial Growth Factor Injections

作者：Clemens Christoph R; Holz Frank G; Meyer Carsten H^*

来源：Journal of Ocular Pharmacology and Therapeutics, 2010, 26(3): 297-299.

DOI：10.1089/jop.2009.0140

Purpose: The aim of this study was to demonstrate the development of a macular hole (MH) and vitreomacular attachment (VMA) after treatment of a subfoveal pigment epithelial detachment (PED) by 3 consecutive antivascular endothelial growth factor (VEGF) injections in a patient with age-related macular degeneration (AMD).
Methods: A 67-year-old woman with a subfoveal PED and occult choroidal neovascularization received 3 consecutive intravitreal ranibizumab injections in her left eye. Her initial visual acuity (VA) was 20/30.
Results: Her VA stabilized at 20/30 at 3 months after the last injection; however, cross-sectional scans using optical coherence tomography (OCT) demonstrated a small vitreous attachment on the retinal surface at the foveola. Two months later, her VA was decreased to 20/100, and on biomicroscopy there was a positive Watzke sign on the center of the PED. OCT disclosed an increased VMA with a full-thickness MH. The perpendicular retina was elevated, whereas the PED appeared stabile.
Conclusion: Consecutive intravitreal injections may alter the vitreous gel, thus inducing a posterior vitreous detachment or VMA. New symptoms after the uploading phase with decreased VA or metamorphopsia may not necessarily relate to a progression of the AMD, but may also relate to a novel incomplete posterior vitreous vitreomacular traction possibly triggering the formation of traction and MH formation.

• 出版日期2010-6