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Ando T, Kubota M, Yasukawa T, Miyase T, Ishiguro K, Esaki Y, Kato A, Kokuzawa S, Hirano Y, Sakaguchi H. 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; 36:102126. [PMID: 39149619 PMCID: PMC11324838 DOI: 10.1016/j.ajoc.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 06/26/2024] [Accepted: 07/12/2024] [Indexed: 08/17/2024] Open
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.
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Affiliation(s)
- Tomoko Ando
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Masaomi Kubota
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Taishi Miyase
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Kiyona Ishiguro
- Department of Ophthalmology, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Yuya Esaki
- Department of Ophthalmology, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Satoko Kokuzawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
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Lee YM, Bahrami B, Selva D, Casson RJ, Chan WO. Scoping review of nonsurgical treatment options for macular holes. Surv Ophthalmol 2024:S0039-6257(24)00043-2. [PMID: 38677557 DOI: 10.1016/j.survophthal.2024.04.005] [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: 10/30/2023] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Macular holes (MH) are full-thickness retinal defects affecting central vision. While vitrectomy with inner limiting membrane (ILM) peel is the conventional MH treatment, non-surgical alternatives are gaining interest to mitigate surgical risks. This study conducted a comprehensive literature review and analysis of nonsurgical MH management. A systematic literature search was conducted on PubMed, Embase, Scopus, and the Cochrane Library from January 1, 1973, to September 13, 2023. Treatments included laser therapy, carbonic anhydrase inhibitors (CAIs), nonsteroidal antiinflammatory drugs (NSAIDs), steroids (topical, subtenons, peribulbar, intravitreal), intravitreal gas, anti-vascular endothelial growth factors and ocriplasmin injections. Data extraction covered study details, patient characteristics, MH features, treatment outcomes, and recurrence rates. The initial search yielded 3352 articles, refined to 83 articles that met inclusion criteria following screening. Overall reported anatomical closure rates were 36% with laser photocoagulation, 37% with intravitreal ocriplasmin, 55% with intravitreal gas. Closures were more frequently observed with topical NSAIDs (79%), steroids (84%) and CAIs (73%). Closures were more often observed in patients with smaller MH and in the presence of cystic macular oedema. Although non-surgical MH management approaches show potential for conservative therapy, evidence is limited to support routine use. Stage 1 and traumatic MH may benefit from a short period of observation, but the gold standard approach for full-thickness MH remains to be vitrectomy with ILM peel.
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Affiliation(s)
- Yong Min Lee
- Ophthalmology department, Royal Adelaide Hospital, Adelaide SA 5000, Australia; Ophthalmology department, Modbury Hospital, Adelaide SA 5000, Australia; Machine Learning Division, Ophthalmic Research Laboratory, University of Adelaide, Adelaide SA 5005, Australia.
| | - Bobak Bahrami
- Ophthalmology department, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Dinesh Selva
- Ophthalmology department, Modbury Hospital, Adelaide SA 5000, Australia
| | - Robert J Casson
- Ophthalmology department, Royal Adelaide Hospital, Adelaide SA 5000, Australia; Machine Learning Division, Ophthalmic Research Laboratory, University of Adelaide, Adelaide SA 5005, Australia
| | - Weng Onn Chan
- Ophthalmology department, Royal Adelaide Hospital, Adelaide SA 5000, Australia; Machine Learning Division, Ophthalmic Research Laboratory, University of Adelaide, Adelaide SA 5005, Australia
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Manayath GJ, Amar SP, Vidhate SS, Kumarswamy KA, Venkatapathy N. Full thickness macular hole with subfoveal pigment epithelial detachment in chronic central serous chorioretinopathy: A therapeutic challenge. Oman J Ophthalmol 2023; 16:336-341. [PMID: 37602183 PMCID: PMC10433045 DOI: 10.4103/ojo.ojo_261_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/04/2023] [Accepted: 03/03/2023] [Indexed: 08/22/2023] Open
Abstract
We describe the diagnostic and therapeutic strategies employed in the management of a patient with subfoveal pigment epithelial detachments (PEDs) combined with full-thickness macular hole (FTMH) and discuss the possible pathophysiology of these diseases occurring concurrently. A 38-year-old patient with a history of central serous chorioretinopathy (CSC) presented with FTMH overlying a large subfoveal serous PED. Multimodal imaging confirmed the same and intravitreal anti-vascular endothelial growth factor (VEGF) injections and eplerenone failed to resolve the PED. Spontaneous resolution of the large PED was observed later and pars plana vitrectomy with internal limiting membrane peeling closed the macular hole successfully. However, the PED with fibrinous CSC recurred postoperatively and low fluence photodynamic therapy (PDT) was done to tackle the same. At 10 months' follow-up, the final vision was 6/9, the macular hole remained closed, and the PED had not recurred. Macular hole formation may be the result of choroidal hyperpermeability and leakage in the backdrop of CSC which gives rise to an exudative component causing mechanical stretching and disruption of the overlying sensory retina. Spontaneous uncomplicated resolution of large subfoveal PED in CSCR is rare. This case was managed with a combination of intravitreal anti-VEGF injections, surgery, and PDT. The therapeutic challenge here was the timing of surgery.
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Affiliation(s)
- George J. Manayath
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Sreelakshmi P. Amar
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Swapnil Shivaji Vidhate
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Karan A. Kumarswamy
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Narendran Venkatapathy
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, 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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Aoki S, Imaizumi H. Simultaneous development of full-thickness macular hole and neovascular age-related macular degeneration. Am J Ophthalmol Case Rep 2022; 25:101325. [PMID: 35146199 PMCID: PMC8801988 DOI: 10.1016/j.ajoc.2022.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/03/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
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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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Sethia A, Sheth J, Gopalakrishnan M, Anantharaman G. Spontaneous formation and closure of full thickness macular hole after treatment with anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy. Indian J Ophthalmol 2020; 67:1756-1758. [PMID: 31546555 PMCID: PMC6786155 DOI: 10.4103/ijo.ijo_1597_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Full-thickness macular hole (FTMH) formation in Polypoidal choroidal vasculopathy (PCV) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment is a rare complication. Spontaneous closure of FTMH following anti-VEGF therapy has not been described in PCV till date. We present a case of Asian woman with PCV who developed a FTMH following treatment with intra-vitreal anti-VEGF injections which subsequently closed spontaneously on further course of treatment.
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Affiliation(s)
- Abhishek Sethia
- Department of Vitreo-Retina, Giridhar Eye Institute, Ernakulam, Kochi, Kerala, India
| | - Jay Sheth
- Department of Vitreo-Retina, Giridhar Eye Institute, Ernakulam, Kochi, Kerala, India
| | - Mahesh Gopalakrishnan
- Department of Vitreo-Retina, Giridhar Eye Institute, Ernakulam, Kochi, Kerala, India
| | - Giridhar Anantharaman
- Department of Vitreo-Retina, Giridhar Eye Institute, Ernakulam, Kochi, Kerala, India
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Lindeke-Myers A, Kokame GT, Yeh S, Shantha J. Successful Treatment of Full-Thickness Macular Hole in Polypoidal Choroidal Vasculopathy with Anti-VEGF Therapy. ACTA ACUST UNITED AC 2020; 4:433-436. [PMID: 34109282 DOI: 10.1177/2474126420909706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To report a case of an 86-year-old man with a full thickness macular hole (FTMH) secondary to polypoidal choroidal vasculopathy (PCV) treated with bevacizumab. Methods A retrospective case report is presented. Results An 86-year-old male presented with a five-month history of metamorphopsia and decreased vision in his right eye and was found to have active exudation secondary to PCV with a concurrent FTMH. After four treatments with intravitreal bevacizumab, the FTMH resolved without surgical intervention. Conclusions The patient's FTMH resolved with solely pharmacologic treatment as a result of treating his PCV with intravitreal bevacizumab. MH formation secondary to PCV is a rare finding, but may be successfully treated with pharmacologic therapy without surgical intervention.
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Affiliation(s)
| | - Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI
- The Retina Center at Pali Momi, Aiea, HI
- Retina Consultants of Hawaii, Honolulu, HI
- Hawaii Macula and Retina Institute, Aiea, HI
- John A. Burns School of Medicine, University of Hawaii School of Medicine, Honolulu, HI
| | - Steven Yeh
- Emory University School of Medicine, Atlanta, GA
- Emory Eye Center, Department of Ophthalmology, Atlanta, GA
| | - Jessica Shantha
- Emory University School of Medicine, Atlanta, GA
- Emory Eye Center, Department of Ophthalmology, Atlanta, GA
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Nagaoka K, Inoda S, Takahashi H, Arai Y, Inoue Y, Takizawa Y, Fujioka S, Kawashima H. A Case of Giant Macular Hole Progression after Rupture of a Giant Retinal Pigment Epithelial Detachment. Case Rep Ophthalmol 2019; 10:195-199. [PMID: 31692603 PMCID: PMC6760363 DOI: 10.1159/000500803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022] Open
Abstract
We report a case of giant macular hole progression after rupture of giant retinal pigment epithelial detachment (PED). The patient was a 91-year-old man who had a giant PED in the left eye. He had bilateral hypermetropia (+2.00 dpt), and he had developed posterior vitreous detachment. The PED was 5,800 μm in diameter and 800 μm in height and ruptured during follow-up. A macular hole was formed, with a diameter of 400 μm, and the height of the PED had reduced to 360 μm. After 5 months, the macular hole expanded up to a diameter of 600 μm. Therefore, some cases of giant PED may lead to macular hole.
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Affiliation(s)
- Kosuke Nagaoka
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
- Totsuka Eye Clinic, Yokohama, Japan
- *Hidenori Takahashi, Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431 (Japan), E-Mail
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
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Tripathy K. Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”. Indian J Ophthalmol 2018; 66:174-175. [PMID: 29283158 PMCID: PMC5778566 DOI: 10.4103/ijo.ijo_733_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Storch M, Hoerauf H. Response to comment on “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”. Indian J Ophthalmol 2018; 66:175. [PMID: 29283159 PMCID: PMC5778567 DOI: 10.4103/ijo.ijo_788_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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