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Märker DA, Radeck V, Lehmann F, Barth T, Helbig H, Eter N, Alten F, Clemens CR. [Iatrogenic retinal defects after intravitreal operative drug injections]. DIE OPHTHALMOLOGIE 2024; 121:129-134. [PMID: 38214731 DOI: 10.1007/s00347-023-01976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Intravitreal operative drug injections represent one of the most frequently performed medical interventions. The risk profile is low. In addition to intraocular pressure elevation, the most frequent complications include exogenous endophthalmitis, vitreous hemorrhage and rhegmatogenous retinal detachment. Furthermore, isolated cases of lens injuries, macular holes associated with vitreoretinal traction and peripheral retinal defects have been described. In the present case series sharp iatrogenic macular and retinal defects are described. METHODS Retrospective multicenter case collection of patients with iatrogenic retinal defects after intravitreal injections from 2016 to 2023. RESULTS Iatrogenic retinal trauma after intravitreal injections for treatment of neovascular age-related macular degeneration was identified in 9 cases (72 years ± 8.1, 3 eyes pseudophakic). While sharp injuries within the macula occurred in six cases, extramacular lesions were detected in the other cases. CONCLUSION Iatrogenic retinal and macular injuries are rare complications of intravitreal injections and when correctly carried out are preventable, especially with respect to use of cannulas and the choice of the distance from the limbus.
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Affiliation(s)
- David A Märker
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland, Franz-Josef-Strauss Allee 11.
| | - Viola Radeck
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland, Franz-Josef-Strauss Allee 11
| | - Fabian Lehmann
- Klinik für Augenheilkunde, Carl-Thiem Klinikum-Cottbus, Cottbus, Deutschland
| | - Teresa Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland, Franz-Josef-Strauss Allee 11
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland, Franz-Josef-Strauss Allee 11
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - Florian Alten
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - Christoph R Clemens
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
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Xie P, Zhu S, Yan R, Wei P, Gao X. Full-Thickness Macular Hole After Intravitreal Conbercept Injection in Branch Retinal Vein Occlusion. Cureus 2023; 15:e34660. [PMID: 36909051 PMCID: PMC9992754 DOI: 10.7759/cureus.34660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/08/2023] Open
Abstract
This article reports a case of macular hole (MH) formation following intravitreal conbercept injection for branch retinal vein occlusion (BRVO). A 70-year-old male received three consecutive intravitreal injections of conbercept for the treatment of macular edema secondary to BRVO in his left eye. Due to the outbreak of the COVID-19 epidemic, the patient was lost to follow-up. At two months follow-up, a full-thickness MH was detected by fundoscopic and optical coherence tomography examination. Fortunately, the MH was successfully closed after pars plana vitrectomy. MH is a rare complication following intravitreal injections for RVO, which should be considered by clinicians.
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Affiliation(s)
- Pinxue Xie
- Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, CHN.,Ophthalmology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, CHN
| | - Siquan Zhu
- Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, CHN
| | - Ran Yan
- Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, CHN
| | - Ping Wei
- Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, USA
| | - Xinxiao Gao
- Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, CHN
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Goel N. FULL-THICKNESS MACULAR HOLE FORMATION AND SPONTANEOUS CLOSURE DURING INTRAVITREAL RANIBIZUMAB THERAPY FOR CENTRAL RETINAL VEIN OCCLUSION. Retin Cases Brief Rep 2022; 16:678-680. [PMID: 33165304 DOI: 10.1097/icb.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the occurrence of full-thickness macular hole formation and spontaneous closure in a case of central retinal vein occlusion treated with intravitreal ranibizumab. METHODS A 67-year-old hypertensive man presented with acute central retinal vein occlusion with macular edema in his left eye for which he received intravitreal ranibizumab. RESULTS He developed a FTMH following the second injection, which was kept under observation. Recurrence of intraretinal edema allowed approximation of the MH edges which subsequently achieved closure with further intravitreal RBZ and formation of an epiretinal membrane. CONCLUSION Full-thickness macular hole formation in acute central retinal vein occlusion after intravitreal ranibizumab, although rare, can occur in eyes with massive macular edema and absence of posterior vitreous detachment after intravitreal pharmacotherapy. Spontaneous closure of secondary holes can take place with improvement in visual acuity.
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Affiliation(s)
- Neha Goel
- Department of Vitreoretina, Eye7 Chaudhary Eye Centre, Daryaganj, New Delhi, India
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Sharpless M, Hogden M. Full-Thickness Macular Hole Closure Following a Single Intravitreal Injection of Aflibercept in an Eye With Diabetic Macular Edema. JOURNAL OF VITREORETINAL DISEASES 2022; 6:457-460. [PMID: 37009537 PMCID: PMC9954781 DOI: 10.1177/24741264221083415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aims to discuss the case of a 32-year-old man with diabetic macular edema (DME) who underwent successful treatment of a full-thickness macular hole (FTMH) with a single dose of aflibercept. Methods: A case report is presented. Results: A 32-year-old man with reduced vision and DME in the right eye was found to have a FTMH. The patient was scheduled for pars plana vitrectomy; however, following a single dose of intravitreal aflibercept, the FTMH closed and the patient avoided surgical intervention. Conclusions: FTMH formation in DME is a rare complication that typically requires surgical intervention. We present a case of FTMH closure after a single dose of intravitreal aflibercept, which to our knowledge is the first of its kind. This report highlights the importance of considering conservative treatment initially to avoid surgery.
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Affiliation(s)
- Michael Sharpless
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Hogden
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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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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Mitra S, Sarpal S, Chattopadhyay A, Paul S, Roy JG. Full-thickness macular hole formation following antivascular endothelial growth factor injection in a case of hemicentral retinal vein occlusion. Oman J Ophthalmol 2021; 14:49-51. [PMID: 34084036 PMCID: PMC8095300 DOI: 10.4103/ojo.ojo_103_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022] Open
Abstract
A rare case reporting the occurrence of full-thickness macular hole (MH) formation following intravitreal antivascular endothelial growth factor injection in a case of hemicentral retinal vein occlusion and the subsequent management of the case. As described in few other similar case reports in the literature, there are quite a few probabilities of factors causing this pathology. An acute posterior vitreous detachment or sudden decompression of the macular edema can quite possibly lead to the above situation. This case report shares light on the evolution of a MH following intravitreal injection and the subsequent treatment process.
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Affiliation(s)
- Srijita Mitra
- Vitreoretina Consultant, Dr. Sarpal Eye Hospital, Amritsar, Punjab, India
| | - Sahil Sarpal
- Vitreoretina Consultant, Dr. Sarpal Eye Hospital, Amritsar, Punjab, India
| | - Abhijit Chattopadhyay
- Department of Retina and Uvea Services, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India
| | - Subhankarsri Paul
- Department of Retina and Uvea Services, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India
| | - Jonaki Ghosh Roy
- Department of Retina and Uvea Services, Priyamvada Birla Aravind Eye Hospital, Kolkata, West Bengal, India
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Closure of macular hole secondary to ischemic hemi-central retinal vein occlusion by retinal photocoagulation and topical anti-inflammatory treatment. Lasers Med Sci 2020; 36:469-471. [PMID: 32827075 PMCID: PMC7881958 DOI: 10.1007/s10103-020-03133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022]
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Clinical presentation and prognostic factors affecting surgical outcomes of secondary macular holes after retinal vein occlusions. Int Ophthalmol 2020; 40:2817-2825. [PMID: 32533452 DOI: 10.1007/s10792-020-01465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe clinical presentation, morphological features and surgical outcomes of macular hole (MH) secondary to retinal vein occlusion (RVO). METHOD This prospective interventional study evaluated eight eyes with atypical MH (secondary to RVO) and data regarding medical management, pars plana vitrectomy, postoperative anatomical hole closure, visual acuity improvement, morphological features of hole were noted till the last follow-up. RESULTS Eight eyes with full-thickness MH in an RVO eye were followed-up for a minimum period of 3 months postoperatively. Five subjects had a RVO episode which occurred more than 6 months before the onset of the recent symptoms (Group 1; 4 branch RVO and 1 central RVO), and 3 subjects had a recent onset branch RVO within 6 months (Group 2). All FTMH cases except one showed closure at the last follow-up. Visual acuity of all eyes improved from 0.91 ± 0.57 logMAR to 0.5 ± 0.3 logMAR (p = 0.093). At baseline, visual acuities of the two groups had no significant difference. Postoperatively, group 1 holes had better visual prognosis, than Group 2 holes, further substantiated by persistence of subretinal fluid in Group 2 eyes till last follow-up. Minimum hole diameter was higher in the recent RVO group, although anatomical closure was obtained in all of these eyes. Most holes had favorable morphological hole features like raised configuration with rounded edges. CONCLUSION In the presence of favorable morphological features, secondary macular holes associated with retinal vein occlusion may show optimal outcomes after surgery. It is not clear whether acutely created holes in recent onset RVO should be operated early. Older holes may have better prognosis.
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Hirata A, Hayashi K, Murata K, Nakamura KI. Removal of choroidal neovascular membrane in a case of macular hole after anti-VEGF therapy for age-related macular degeneration. Am J Ophthalmol Case Rep 2017; 9:14-17. [PMID: 29468210 PMCID: PMC5786856 DOI: 10.1016/j.ajoc.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/03/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose The formation of macular hole after receiving anti-vascular endothelial growth factor (anti-VEGF) therapy is rare. We report a case of macular hole that occurred after intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD) in a patient, who underwent vitrectomy combined with choroidal neovascularization (CNV) removal. Observations A 64-year-old female with AMD affecting her right eye received an intravitreal injection of an anti-VEGF agent. After treatment, we identified a full thickness macular hole (MH) that was associated with the rapid resolution of the macular edema and contraction of the CNV. After performing vitrectomy combined with CNV removal, the MH closed and her visual acuity improved. Examination of the removed CNV revealed a network of microvessels devoid of pericytes. Conclusions and importance The present findings suggest that rapid resolution of macular edema and contraction of the CNV and/or mild increase in the vitreous traction after anti-VEGF therapy could potentially cause MH. CNV removal via the MH may be an acceptable procedure, if the MH remains open, the CNV is of the classic type, and it spares a central portion of the fovea.
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Affiliation(s)
- Akira Hirata
- Hayashi Eye Hospital, Fukuoka, Japan
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
- Corresponding author. Hayashi Eye Hospital, 4-23-35, Hakataekimae, Fukuoka 812-0011, Japan.Hayashi Eye Hospital4-23-35, HakataekimaeFukuoka812-0011Japan
| | | | - Kazuhisa Murata
- Department of Ophthalmology, Saga University Faculty of Medicine, Saga, Japan
| | - Kei-ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
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