J Korean Ophthalmol Soc.  2010 May;51(5):774-778.

Macular Hole Following Intravitreal Ranibizumab Injections for Choroidal Neovascularization

• Jo YJ
• Kim KN
• Lee JE
• Kim JY

Abstract

PURPOSE
To report a case of macular hole following intravitreal ranibizumab injection in choroidal neovascularization associated with age-related macular degeneration.
CASE SUMMARY
A 73-year-old man was referred for a sudden decline in vision in his right eye. The best corrected visual acuity was 0.15 in the right eye and 0.9 in the left eye. There was a choroidal neovascularization associated with subretinal hemorrhage in the right eye. Optical coherence tomogram (OCT) showed subretinal hemorrhage and pigment retinal epithelium detachment in the right eye. The patient received intravitreal ranibizumab injection. Four weeks after the initial treatment, the best corrected visual acuity of the right eye was improved to 0.3. The patient received a second intravitreal ranibizumab injection. Four weeks after the second injection, the patient presented with further decreased vision in his right eye, with a best corrected visual acuity of 0.02. Although the fundus examination was indistinct, OCT confirmed the presence of a full thickness macular hole. The patient received a third intravitreal ranibizumab injection. Four weeks after receiving the third injection, the patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-gas exchange. Four months later, the macula hole was closed completely and visual acuity was 0.1.
CONCLUSIONS
Although it is rare, intravitreal ranibizumab injection in the treatment of choroidal neovascularization secondary to age-related macular degeneration may cause complicated by a macular hole.

Keyword

Age related macular degeneration; Choroidal neovascularization; Macula hole; Ranibizumab

MeSH Terms

Aged
Antibodies, Monoclonal, Humanized
Choroid
Choroidal Neovascularization
Epithelium
Eye
Hemorrhage
Humans
Macular Degeneration
Membranes
Retinal Perforations
Retinaldehyde
Vision, Ocular
Visual Acuity
Vitrectomy
Ranibizumab
Antibodies, Monoclonal, Humanized
Retinaldehyde

Figure

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  Figure 1. (A) Fundus photograph before an intravitreal ranibizumab® injection shows a juxtafoveal grayish subretinal membrane with submacular hemorrhage. (B) Optical coherence tomography reveals a macular edema and a pigment epithelial detachment. There is a mild vitreomacular traction (arrow). (C) Fluorescein angiograph shows a blocked fluorescence due to thick submacular hemorrhage. (D) Indocyanine green angiograph demonstrates a well demarcated area of hyperfluorescence in the juxtafoveal area corresponding to the choroidal neovascularization.

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  Figure 2. (A) Fundus photograph after the second intravitreal ranibizumab® injection shows that submacular hemorrhage was disappeared. It is difficult to find out the macular hole. (B) Optical coherence tomograph confirms the presence of a full thickness macular hole with operculum.

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  Figure 3. (A) Fundus photograph four months after the vitrectomy, the internal limiting membrane peeling and the fluid-gas exchange. (B) Optical coherence tomographs show that the macular hole was closed completely.

Reference

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