Macular hole with retinal pigment epithelium tear after anti-VEGF therapy in an eye with neovascular age-related macular degeneration

Am J Ophthalmol Case Rep. 2024 Jul 17:36:102126. doi: 10.1016/j.ajoc.2024.102126. eCollection 2024 Dec.

Abstract

Purpose: To report a case of a full-thickness macular hole (FTMH) associated with a retinal pigment epithelium (RPE) tear after anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nvAMD), which was successfully closed by vitreous surgery.

Observations: A 73-year-old man with nvAMD in the right eye received an intravitreal aflibercept injection due to enlarged pigment epithelial detachment. However, 2 days after the third injection, the patient experienced a sudden decline in vision. An FTMH with a tear in the underlying RPE was detected. The FTMH was closed using vitrectomy combined with the inverted internal limiting membrane (ILM) flap technique.

Conclusions and importance: Our case highlights a rare complication of both an FTMH and an RPE tear after anti-VEGF therapy. Vitrectomy, with the inverted ILM flap technique, proved effective in closing the FTMH despite the complexity of the case.

Keywords: Age-related macular degeneration; Anti-vascular endothelial growth factor therapy; Macular hole; Pigment epithelial detachment; Retinal pigment epithelial tear.

Publication types

  • Case Reports