Department of Ophthalmology, McGill University Health Centre, Montreal, Québec, Canada.
Retin Cases Brief Rep. 2020 Summer;14(3):255-259. doi: 10.1097/ICB.0000000000000688.
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.
Case report with spectral domain optical coherence tomography retinal imaging.
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.
In wet AMD eyes with previously closed macular holes, hole reopening may occur as a rare complication of aflibercept therapy.
描述一位湿性年龄相关性黄斑变性患者在接受阿柏西普注射治疗后全层黄斑裂孔复发的临床病程和手术结果。
病例报告并结合频域光相干断层扫描视网膜成像。
一位 84 岁的患者，右眼曾于 4 年前接受玻璃体切除术和内界膜（ILM）剥除术成功封闭全层黄斑裂孔，现同一眼发生新生血管性年龄相关性黄斑变性（AMD）。在接受 6 次玻璃体内阿柏西普注射后，视力为 20/50，仅有少量视网膜下液（SRF）。在第 7 次阿柏西普注射后 4 天，视力下降至 20/200。频域光相干断层扫描显示直径为 430μm 的全层黄斑裂孔重新开放，伴有色素上皮脱离高度降低、SRF 增加和视网膜内膜（ERM）。行 23G 经睫状体平坦部玻璃体切除术，并用吲哚青绿辅助去除残余 ILM 和 ERM，并进行 20%六氟化硫（SF6）眼内填充。术后 1 个月，全层黄斑裂孔成功闭合，视力提高至 20/80。
在先前已封闭黄斑裂孔的湿性 AMD 眼中，裂孔再开放可能是阿柏西普治疗的罕见并发症。
