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FULL-THICKNESS MACULAR HOLE IN AGE-RELATED MACULAR DEGENERATION PATIENTS WITH TWO DISTINCT ENTITIES: A Multicenter Study. Retina 2021; 41:2066-2072. [PMID: 34310095 DOI: 10.1097/iae.0000000000003141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe optical coherence tomography characteristics of full-thickness macular holes (FTMHs) in age-related macular degeneration patients. METHODS A multicenter, retrospective, observational case series of patients diagnosed with age-related macular degeneration and FTMHs seen between January 1, 2009, and January 3, 2020. Clinical charts and spectral-domain optical coherence tomography images were reviewed. Optical coherence tomography findings included FTMH-inverted trapezoid or hourglass appearance, central macular thickness (CMT), complete retinal pigment epithelium and complete retinal outer retinal atrophy, and presence of pigment epithelium detachment and epiretinal membrane. The mean outcome was the morphologic and functional characterization of different subtypes of FTMHs. RESULTS A total of 86 eyes of 85 consecutive patients, with mean age of 80.31 ± 8.06 and mean best-corrected visual acuity of 1.17 ± 0.58 logarithm of the minimal angle of resolution. Two different subtypes of FTMHs were identified: tractional and degenerative. Fifty (58%) degenerative FTMHs characterized with inverted trapezoid appearance and 36 (42%) tractional FTMHs characterized with hourglass appearance. Degenerative FTMHs presented with 66% of CMT < 240 µm, 14% of CMT > 320, and 70% of complete retinal outer retinal atrophy, in comparison with 41% of CMT < 240 µm, 42.9% of CMT > 320%, and 20% of complete retinal outer retinal atrophy in the tractional FTMH group (P = 0.002, 0.003, <0.001, respectively). The presence of epiretinal membrane and pigment epithelium detachment where significantly higher in tractional FTMHs (P = 0.02, 0.03, respectively). CONCLUSION Degenerative and tractional FTMHs may be two distinct clinical entities. Discerning degenerative from tractional FTMHs is possible by using optical coherence tomography features including shape of the FTMHs, CMT, internal-external ratio of FTMHs, and presence of complete retinal outer retinal atrophy, pigment epithelium detachment, and epiretinal membrane.
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MACULAR HOLE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION: Pathogenesis and Surgical Outcomes. Retina 2021; 41:2079-2087. [PMID: 34543242 DOI: 10.1097/iae.0000000000003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain the pathogenesis of macular hole (MH) associated with age-related macular degeneration (AMD) and its surgical outcomes. METHODS Patients with full-thickness MH associated with AMD (higher grades than intermediate) were enrolled. The mechanism of MH formation and closure rate after vitrectomy (surgical outcome) were determined using optical coherence tomography imaging. RESULTS The mechanism of MH formation (35 eyes) associated with AMD was classified into four types: vitreomacular traction (42.9%), gradual retinal thinning caused by subretinal drusen or pigment epithelial detachment (22.9%), massive subretinal hemorrhage (20.0%), and combined (14.3%). In the 41 eyes that underwent vitrectomy, the logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.82 (0.10-2.30) preoperative to 0.69 (0.10-2.30) postoperative (P = 0.001). Successful closure of the MH was achieved in 33 eyes (80.5%) after vitrectomy. No significant association was observed between the closure rate of MH after vitrectomy and mechanism of MH formation (P = 0.083). CONCLUSION The mechanism of MH formation associated with AMD was classified into four types and was not related to its surgical outcome. Considering visual improvement and surgical outcome after vitrectomy in our study, active surgical treatment can be considered for MH associated with AMD.
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Kayaarasi Ozturker Z, Akca Bayar S, Yaman Pinarci E, Kurt RA, Akkoyun I, Yilmaz G. Atypical macular hole formation after Anti-VEGF therapy for neovascular age-related macular degeneration: Coincidence or consequence? ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:455-461. [PMID: 34479701 DOI: 10.1016/j.oftale.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Age-related macular degeneration (AMD) is the primary cause of blindness in developed countries, particularly in older adults. Anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection is the current standard treatment for neovascular form of AMD. Studies reporting macular hole (MH) formation following anti-VEGF treatment are limited, and the exact pathogenesis is still under discussion. With the present study, we aim to analyse the clinical features of eyes developing MH after anti-VEGF therapy for neovascular AMD. MATERIALS AND METHODS Patients were treated with intravitreal anti-VEGF agents for at least one year and stable for at least six months. Best-corrected visual acuity (BCVA) and optical coherence tomography findings were evaluated. RESULTS Nineteen eyes of 18 patients were included in this study. Patients had an average age of 77.7 years at first visit and eight were female. The average number of injections before the MH formation was four. MH developed after a mean follow-up of 5.1 months after the last injection. Sixteen eyes had (84.2%) had choroidal neovascular membrane without any abnormal vitreomacular traction. Eleven eyes (57.8%) had retinal pigment epithelium detachment (PED), two (10.5%) had an epiretinal membrane (ERM), and one (5.2%) had retinal pigment epithelium (RPE) tear. The mean first and last BCVA was 1.07±0.48 LogMAR (0.3-1.8) and 1.16±0.38 logMAR (0.4-1.8), respectively. CONCLUSIONS A macular hole can be observed in AMD patients receiving anti-VEGF therapy. Increased fibrovascular scar tissue due to subretinal fluid resolution, neovascular membrane contraction, and the presence of PED, RPE tear, and ERM may contribute to MH formation.
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Affiliation(s)
- Z Kayaarasi Ozturker
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Istanbul Hospital, Estambul, Turkey.
| | - S Akca Bayar
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Ankara Hospital, Ankara, Turkey
| | - E Yaman Pinarci
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Istanbul Hospital, Estambul, Turkey
| | - R A Kurt
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Istanbul Hospital, Estambul, Turkey
| | - I Akkoyun
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Ankara Hospital, Ankara, Turkey
| | - G Yilmaz
- Baskent University, Faculty of Medicine, Department of Ophthalmology, Ankara Hospital, Ankara, Turkey
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Meyer PS, Kammann MT, Meyer CH. Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature. Am J Ophthalmol Case Rep 2021; 23:101154. [PMID: 34286160 PMCID: PMC8280528 DOI: 10.1016/j.ajoc.2021.101154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To present the surgical treatment of a full thickness macular hole (MH) caused by a vitreomacular traction (VMT) on top of an adjacent subfoveal pigment epithelial detachment (PED) in age-related macular degeneration (AMD). OBSERVATION A 77-year-old female with a subfoveal PED receiving consecutive intravitreal injections noticed a sudden decreased visual acuity (VA) due to the development an occult MH in her right eye after 19 repeated intravitreal anti vascular endothelial growth factor (VEGF)-injections. Her initial VA declined from 20/50 to 20/400. The firm VMT induced a rupture of the multi-layered retina and may progress to an RPE-tear or possible to a subretinal haemorrhage. We discussed with the patient the risks of the natural progression and explained possible treatment options: We continued her anti-VEGF combined with air bubble injections to induce a posterior vitreous detachment, to stabilise the retinal architecture, reduce the subretinal fluid and avoid possible intraoperative bleeding. As injections did release the VMT, vitrectomy released the posterior vitreous from the optic nerve and trimmed it towards the central retina. Peeling with brilliant blue removed the internal limiting membrane without any signs of bleeding, rupture of the PED or enlargement of the MH, prior to the installation of 10% SF6 gas. The postoperative optical coherence tomography (OCT) on day 5 confirmed a closed MH, while the size, shape and pattern of the PED remained unchanged. Her VA increased from 20/400 to 20/50 (equal to her previous VA prior to the MH-formation). To avoid a potential progression of the PED, we maintained her retreatment intervals at 5 weeks for the next 6 months. A literature review presents similar intraoperative approaches and postoperative outcomes in 8 out of the 9 published cases. CONCLUSIONS AND IMPORTANCE VMT can induce an occult MH on top of a PED, causing a significant loss of vision. When gas injections are not successful, surgery may release the traction, restore the retinal architecture, and significantly improve and maintain the VA over a documented long-term observation. The epiretinal procedure should be assisted under regular anti-VEGF injections to maintain the subretinal architecture.
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Doshi S, Gulati M, Pathengay A, Hegde S. Spontaneous closure of macular hole in a case of toxoplasma retinochoroiditis. Indian J Ophthalmol 2021; 68:915-916. [PMID: 32317485 PMCID: PMC7350478 DOI: 10.4103/ijo.ijo_1262_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shreyansh Doshi
- Vitreoretina and Uveitis Services, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Megha Gulati
- Vitreoretina and Uveitis Services, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Services, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Sharat Hegde
- Department of Vitreoretina and Uveitis, Prasad Netralaya, Udipi, Karnataka, India
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REOPENING OF MACULAR HOLE AFTER INTRAVITREAL AFLIBERCEPT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retin Cases Brief Rep 2021; 14:255-259. [PMID: 29252912 DOI: 10.1097/icb.0000000000000688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the clinical course and surgical outcome of a patient with full-thickness macular hole recurrence after aflibercept injections for wet age-related macular degeneration. METHODS Case report with spectral domain optical coherence tomography retinal imaging. RESULTS An 84-year-old patient, with a successfully closed full-thickness macular hole by vitrectomy and internal limiting membrane (ILM) peel 4 years ago in the right eye, developed neovascular age-related macular degeneration (AMD) of the same eye. After 6 intravitreal aflibercept injections, visual acuity was 20/50, with minimal subretinal fluid (SRF). Four days after the seventh aflibercept injection, visual acuity decreased to 20/200. Spectral domain optical coherence tomography demonstrated a reopened full-thickness macular hole of diameter 430 μm, associated with a reduction in pigment epithelial detachment height, increase in SRF, and an epiretinal membrane (ERM). A 23-gauge pars plana vitrectomy with indocyanine green-assisted removal of residual ILM and ERM, and sulfur hexafluoride (SF6) 20% tamponade was performed. At 1 month postoperatively, the full-thickness macular hole was successfully closed and visual acuity improved to 20/80. CONCLUSION In wet AMD eyes with previously closed macular holes, hole reopening may occur as a rare complication of aflibercept therapy.
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Nawrocka ZA, Nawrocka Z, Nawrocki J. Vitrectomy for full thickness macular hole developed during the course of anti-VEGF treatment of type 1 neovascular AMD. Eur J Ophthalmol 2021; 32:NP5-NP8. [PMID: 33740870 DOI: 10.1177/11206721211002123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of treatment of a full-thickness macular hole, which appeared after 10 months of anti-VEGF treatment in neovascular age related macular degeneration (nAMD). METHODS The patient was diagnosed as type 1 nAMD. The coexisting vitreomacular traction caused a full thickness macular hole after 10 months of treatment. PATIENTS A 68-year-old woman treated with anti VEGF. RESULTS Vitrectomy with the temporal inverted ILM flap technique succeeded in closing the hole. Further anti-VEGF treatment followed. CONCLUSION FTMH is a rare complication or coexistence in nAMD. Vitrectomy and continuous anti-VEGF treatment might result in satisfactory anatomical and functional results.
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Sato A, Fukui E, Ohta K. Macular Hole Formation in Eye After Cryotherapy and Intravitreal Bevacizumab Treatment for Vasoproliferative Tumor. Int Med Case Rep J 2020; 13:419-423. [PMID: 32982482 PMCID: PMC7501591 DOI: 10.2147/imcrj.s266986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of a full-thickness macular hole (MH) that developed after cryotherapy and intravitreal bevacizumab injection (IVB) to treat a retinal vasoproliferative tumor (VPT). Methods Case report of a man with a retinal VPT. Results A 64-year-old Japanese man complained of blurred vision in his right eye. At the initial examination, his best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/20 in the left eye. Ophthalmoscopy showed a VPT in the lower peripheral retina of the right eye. An exudative retinal detachment and hard exudates were seen around the tumor. Cryotherapy and intravitreal injections of bevacizumab (IVB) were performed. Although the exudative changes were reduced, a MH developed two months after the initial IVB treatment. He underwent 25-gauge pars plana vitrectomy, and the MH was closed. His postoperative BCVA was 20/32 and the VPT was inactive. The reduced BCVA was due to damage of the outer retinal layers. Conclusion Our findings indicate that cryotherapy and IVB are effective treatments for VPT although the possibility of developing a MH should be considered.
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Affiliation(s)
- Atsuko Sato
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Emi Fukui
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Kouichi Ohta
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
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Abstract
PURPOSE To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs). METHODS A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded. RESULTS Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is. CONCLUSION With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.
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Sun CB, Wang Y, Zhou S, Fang X, Xu D, Liu Z. Macular hole retinal detachment after intravitreal Conbercept injection for the treatment of choroidal neovascularization secondary to degenerative myopia: a case report. BMC Ophthalmol 2019; 19:156. [PMID: 31331298 PMCID: PMC6647155 DOI: 10.1186/s12886-019-1164-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report a case of macular hole (MH) formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization (CNV) secondary to degenerative myopia. CASE PRESENTATION A 60-year-old woman presented with blurred vision in her left eye was diagnosed as CNV secondary to degenerative myopia. Intravitreal injection of conbercept, an anti -vascular endothelial growth factor (VEGF) agent, was uneventfully performed in the left eye. Unfortunately, a full thickness MH and retinal detachment was found three weeks postoperatively by ophthalmoscopy and spectral-domain optical coherence tomography. Vitrectomy, internal limiting membrane peeling and silicone oil tamponade were then performed, and macular retina was reattached soon after surgery. However, MH still kept open during three months' follow-up. CONCLUSION MH is a quite rare complication of intravitreal anti- VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.
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Affiliation(s)
- Chuan-Bin Sun
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yueye Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Shiyang Zhou
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xudong Fang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Danni Xu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhe Liu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310015, China.
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Characteristics and Outcomes of Full-thickness Macular Hole Repair in Patients Receiving Anti-VEGF Injections for Neovascular Age-related Macular Degeneration. Int Ophthalmol Clin 2018; 59:127-135. [PMID: 30585922 DOI: 10.1097/iio.0000000000000248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Torabi H, Jadidi K, Naderi M. Lamellar macular hole formation following intravitreal bevacizumab injection for choroidal neovascularization by age-related macular degeneration. Oman J Ophthalmol 2018; 11:277-279. [PMID: 30505124 PMCID: PMC6219339 DOI: 10.4103/ojo.ojo_33_2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This report describes a lamellar macular hole formation subsequent to intravitreal bevacizumab injection for the treatment of choroidal neovascularization (CNV) by age-related macular degeneration. A 67-year-old woman with bilateral CNV underwent 3 monthly intravitreal bevacizumab injections in her both eyes. One month after the third bilateral injection, vision loss happened. Optical coherence tomography performed for further evaluation that showed reduction of intra- and sub-retinal fluid associated with lamellar macular hole development in both eyes. Although macular hole formation, especially bilateral form, is a rare complication of intravitreal injections, surgeons should consider macular hole development in cases with vision deterioration following intravitreal bevacizumab injection.
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Affiliation(s)
- Hamidreza Torabi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Naderi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Kabanarou SA, Xirou T, Mangouritsas G, Garnavou-Xirou C, Boutouri E, Gkizis I, Chatziralli I. Full-thickness macular hole formation following anti-VEGF injections for neovascular age-related macular degeneration. Clin Interv Aging 2017; 12:911-915. [PMID: 28603410 PMCID: PMC5457126 DOI: 10.2147/cia.s135364] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Macular hole (MH) is part of a group of age-related degenerative diseases characterized by pathology of vitreomacular interface. Similarly, neovascular age-related macular degeneration (nAMD) affects older patients and is a leading cause of irreversible visual loss. The purpose of this case series is to describe the development of full-thickness MH in patients with nAMD, following antivascular endothelial growth factor (anti-VEGF) treatment. METHODS Participants in this case series were four patients with nAMD, who received anti-VEGF injections with variable therapeutic response to treatment. Patients were examined at baseline (when AMD was diagnosed) and monthly thereafter. The examination included visual acuity measurement, slit-lamp biomicroscopy, and optical coherence tomography. RESULTS All patients were found to develop full-thickness MH within 1-4 months after the last anti-VEGF injection, even in the absence of pre-existing vitreomacular interface abnormalities in some cases. The median number of injections before the MH formation was 3. CONCLUSION MH formation may represent an adverse effect of anti-VEGF treatment in patients with nAMD and could be also coexisting pathology with nAMD in older individuals.
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Affiliation(s)
- Stamatina A Kabanarou
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Tina Xirou
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - George Mangouritsas
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | | | - Eirini Boutouri
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Ilias Gkizis
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Kinra V, Singh S, Khanduja S, Nada M. Evaluation of vitreoretinal interface changes in patients receiving intravitreal anti-VEGF therapy. Int Ophthalmol 2017; 38:549-556. [PMID: 28299498 DOI: 10.1007/s10792-017-0490-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To study the effects of repeated intravitreal injection of anti-VEGF drug bevacizumab on the vitreoretinal interface (VRI). METHODS Patients undergoing intravitreal injection of bevacizumab were enrolled. Eyes with media haze, uveitis, high myopia, history of cataract surgery or laser capsulotomy in last 6 months and complicated pseudophakia were excluded. VRI evaluation was done monthly for a minimum of 6 months. The nature and timing of the change(s) event was recorded. RESULTS A total of 100 eyes were evaluated. Thirty-seven eyes developed new vitreoretinal interface change event (VICE). Pseudophakia (OR = 5.23, 95% CI = 1.99-14.07, p = 0.001), pre-injection VRI abnormality (OR = 2.63, 95% CI = 1.13-6.14, p = 0.024) and older age at enrollment (62.6 ± 13.9 vs. 56.3 ± 14 years) were risk factors for development of VICE. Eighty percent of interface events occurred in the first 3 months of therapy. Eight needed surgical intervention for consequences of vitreoretinal separation. CONCLUSION VICE is not infrequent in eyes receiving anti-VEGF therapy though rarely need surgical intervention. The first 3 months are the critical months to watch out for these events. The treating ophthalmologists must keep the risk factors for development of in mind and monitor and counsel patients accordingly.
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Affiliation(s)
- Vartika Kinra
- Regional Institute of Ophthalmology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Satvir Singh
- Regional Institute of Ophthalmology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sumeet Khanduja
- Regional Institute of Ophthalmology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
| | - Manisha Nada
- Regional Institute of Ophthalmology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Lee G, Lee S. Full-thickness Macular Hole after Intravitreal Aflibercept Injection in a Patient with Wet Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.7.875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gwonhwee Lee
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Seungwoo Lee
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
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Muramatsu D, Mitsuhashi R, Iwasaki T, Goto H, Miura M. Macular hole formation following intravitreal injection of ranibizumab for branch retinal vein occlusion: a case report. BMC Res Notes 2015; 8:358. [PMID: 26285577 PMCID: PMC4541740 DOI: 10.1186/s13104-015-1324-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background Macular hole formation after anti-vascular endothelial growth factor therapy is a rare complication. We report macular hole formation after intravitreal ranibizumab injection for branch retinal vein occlusion. Case presentation A 63-year-old Asian male was treated with intravitreal ranibizumab injection for chronic macular edema with branch retinal vein occlusion in his right eye. Before treatment, best-corrected visual acuity in his right eye was 20/200. Nine days after injection, a full thickness macular hole developed with reduction of macular edema. After pars plana vitrectomy combined with cataract surgery, the macular hole was successfully closed, and the best-corrected visual acuity in his right eye improved to 20/40. Conclusion The possibility of an infrequent complication like macular hole should be considered for intravitreal ranibizumab for macular edema with branch retinal vein occlusion.
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Affiliation(s)
- Daisuke Muramatsu
- Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan.
| | - Ryosuke Mitsuhashi
- Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan.
| | - Takuya Iwasaki
- Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan.
| | - Hiroshi Goto
- Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Masahiro Miura
- Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan.
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Oshima Y, Apte RS, Nakao S, Yoshida S, Ishibashi T. Full thickness macular hole case after intravitreal aflibercept treatment. BMC Ophthalmol 2015; 15:30. [PMID: 25881212 PMCID: PMC4381494 DOI: 10.1186/s12886-015-0021-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/19/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathogenesis of macular hole formation is widely accepted as a tractional force at the vitreo-retinal interface in fovea. We report a case of macular hole after intravitreous aflibercept injection for age-related macular degeneration (AMD) associated with contraction of the retinal pigment epithelium (RPE) at the edge of a fibrovascular pigment epithelial detachment (PED). CASE PRESENTATION A 94-year old man with neovascular AMD affecting his left eye accompanied by a fibrovascular PED was examined for severe vision loss. Although RPE tear in his left eye was identified before the first aflibercept intravitreous injection performed in order to treat neovascular AMD, he received three aflibercept injections as induction treatment. After induction treatment, a full thickness macular hole was identified associated with the contracted rolled RPE edge beneath the retina. CONCLUSION Macular hole is commonly formed associated with tangential vitreous traction. Current report suggests that rapid contraction of the RPE underneath the retina can be one of the causes of a macular hole, and one of the side effects of anti-VEGF therapy for neovascular AMD.
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Affiliation(s)
- Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shigeo Yoshida
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Tufan HA, Gencer B, Kara S. Macular hole after intravitreal bevacizumab injection for choroidal neovascularisation. Clin Exp Optom 2013; 97:178-80. [PMID: 23331251 DOI: 10.1111/cxo.12009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 08/06/2012] [Accepted: 08/14/2012] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to report a patient who developed a full-thickness macular hole following intravitreal bevacizumab injection. METHODS A 78-year-old patient diagnosed with choroidal neovascularisation (CNV) was treated with intravitreal bevacizumab injection. RESULTS On the first follow-up visit, a decrease in visual acuity was seen and a small full-thickness macular hole with complete resolution of subretinal fluid was observed in optical coherence tomography (OCT). A second intravitreal injection of bevacizumab was performed. At the subsequent visit, a serious loss of visual acuity and limited regression in choroidal neovascularisation was seen. The OCT showed a larger full-thickness macular hole. CONCLUSIONS This case demonstrates that intravitreal bevacizumab injection might be responsible for the development of a macular hole. Clinicians should be cautious that a macular hole may be a complication of intravitreal bevacizumab injection.
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Affiliation(s)
- Hasan Ali Tufan
- Department of Ophthalmology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
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Kim JM, Jang JW, Kyung SE, Chang MH. Macular Hole after Single Intravitreal Injection of Ranibizumab in a Patient with Age-Related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.7.1130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Min Kim
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Jun Won Jang
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Sung Eun Kyung
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Moo Hwan Chang
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
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Erdurman FC, Pellumbi A, Durukan AH. Lamellar macular hole formation in a patient with diabetic CME treated by intravitreal bevacizumab injections. Ophthalmic Surg Lasers Imaging Retina 2012; 43 Online:e87-9. [PMID: 22938703 DOI: 10.3928/15428877-20120823-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 07/11/2012] [Indexed: 11/20/2022]
Abstract
A 49-year-old woman with a diagnosis of diabetic cystoid macular edema in both eyes presented with the appearance of a macular hole in the left eye 1 month after intravitreal bevacizumab injection. Optical coherence tomography demonstrated a lamellar macular hole in the left eye. Although vitreomacular traction and epiretinal membrane are the possible underlying causes for the development of lamellar macular hole formation in eyes with cystoid macular edema, in this case previous optical coherence tomography scans revealed the complete separation of the posterior hyaloid membrane and the absence of an epiretinal membrane. The exact mechanism involved in the progression of cystoid macular edema to lamellar macular hole and the contribution of the intravitreal bevacizumab injections to this transformation remain unclear.
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Affiliation(s)
- F Cuneyt Erdurman
- Department of Ophthalmology, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey.
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Xu L, Kanasaki K, Kitada M, Koya D. Diabetic angiopathy and angiogenic defects. FIBROGENESIS & TISSUE REPAIR 2012; 5:13. [PMID: 22853690 PMCID: PMC3465576 DOI: 10.1186/1755-1536-5-13] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/12/2012] [Indexed: 12/31/2022]
Abstract
Diabetes is one of the most serious health problems in the world. A major complication of diabetes is blood vessel disease, termed angiopathy, which is characterized by abnormal angiogenesis. In this review, we focus on angiogenesis abnormalities in diabetic complications and discuss its benefits and drawbacks as a therapeutic target for diabetic vascular complications. Additionally, we discuss glucose metabolism defects that are associated with abnormal angiogenesis in atypical diabetic complications such as cancer.
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Affiliation(s)
- Ling Xu
- Division of Diabetology & Endocrinology, Kanazawa Medical University, Uchinada, Ishikawa, 920-0293, Japan.
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