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 Table of Contents    
CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 277-279  

Lamellar macular hole formation following intravitreal bevacizumab injection for choroidal neovascularization by age-related macular degeneration


Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Date of Web Publication29-Oct-2018

Correspondence Address:
Dr. Hamidreza Torabi
Health Management Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Street, Vanak Square, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_33_2017

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   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.

Keywords: Choroidal neovascularization, intravitreal bevacizumab, lamellar macular hole, neovascular age-related macular degeneration


How to cite this article:
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;11:277-9

How to cite this URL:
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 [serial online] 2018 [cited 2018 Dec 12];11:277-9. Available from: http://www.ojoonline.org/text.asp?2018/11/3/277/244328




   Introduction Top


Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among people over 50-year-old in the developed countries.[1] Anti-vascular endothelial growth factor (VEGF) agents have changed the management and prognosis of exudative form of AMD.[2]

Bevacizumab (Avastin, Genentech, Inc., San Francisco, CA, USA) is a recombinant humanized monoclonal antibody targeting all isoforms of VEGF. Intravitreal bevacizumab injection is an effective option in the treatment of many retinopathies that are associated with VEGF upregulation such as neovascular AMD,[3],[4] proliferative diabetic retinopathy,[5],[6] neovascular glaucoma,[7],[8] retinal vascular occlusions,[9],[10] and retinopathy of prematurity.[11]

The most commonly reported ocular complications of intravitreal bevacizumab injection include endophthalmitis, cataract formation, retinal pigment epithelial (RPE) tears, retinal breaks and retinal detachment.[2] There are few reports of macular hole formation following intravitreal bevacizumab injection.[12],[13] Here, we report a case of bilateral lamellar macular hole formation after intravitreal bevacizumab injection for the treatment of wet-type AMD.


   Case Report Top


A 67-year-old woman presented to us with bilateral vision loss for 1 year. She had a history of uncomplicated phacoemulsification cataract operation about 4 years ago and 2 monthly intravitreal bevacizumab injections in her both eyes. Best-corrected visual acuity (BCVA) was counting fingers at 5 m in her both eyes. Funduscopic examination revealed a few macular drusen in each eye along with small areas of preretinal hemorrhage and cystoid macular edema. Spectral domain optical coherence tomography (OCT) showed hyperreflective sub-RPE material, intra- and sub-retinal fluid and vitreomacular adhesion [Figure 1]a and [Figure 1]b. Fluorescein angiography showed late leakage in the macular area. These findings were compatible with choroidal neovascularization (CNV).
Figure 1: (a and b) Macular optical coherence tomography of the right (a) and left eye (b) before the third bilateral intravitreal bevacizumab injection

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The third bilateral intravitreal bevacizumab injection (1.25 mg/0.05 ml) was performed, and the patient was followed up. One month after the third injection, the patient's BCVA deteriorated to counting fingers at 2 meters in both eyes. OCT was performed and revealed lamellar macular hole associated with operculum in both eyes. Furthermore, Postinjection OCT demonstrated reduction of intra- and sub-retinal fluid [Figure 2]a and [Figure 2]b.
Figure 2: (a and b) Macular optical coherence tomography of the right (a) and left eye (b) 1 month after the third injection

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   Discussion Top


We present a patient with neovascular AMD who developed bilateral lamellar macular hole after intravitreal bevacizumab injection in her both eyes. Macular hole formation is a very rare complication of intravitreal injections and has been reported only in a small number of case reports. Moisseiev et al. reported an 86-year-old man underwent intravitreal bevacizumab injection for the treatment of unilateral subfoveal CNV.[13] The patient had a history of previous treatment with 6 times intravitreal bevacizumab injections. One month after the seventh injection, his visual acuity had worsened and OCT demonstrated a full-thickness macular hole. Furthermore, Tufan et al. described a 78-year-old man diagnosed with right eye CNV who was treated with intravitreal bevacizumab injection.[2] One month after the injection, visual acuity reduced and full-thickness macular hole was noticed.

To date, the exact mechanism of lamellar macular hole formation following intravitreal injections remains unclear. Contraction of the prefoveal vitreous cortex following intravitreal injections may result in focal traction which can cause macular hole development.[14] Such tractions may occur secondary to vitreous incarceration at the site of injection.[13],[14],[15] Alternatively, it is possible that the macular hole develops secondary to posterior vitreous detachment (PVD) following intravitreal injection. Preinjection OCT demonstrated that PVD did not happen in both eyes of our case, and tractional force during PVD may have been caused the macular hole formation.


   Conclusion Top


It seems that lamellar macular hole may develop after intravitreal bevacizumab injection. Consequently, the potential sight-threatening complication should be informed to the patients. Moreover, surgeons should consider macular hole development in cases with vision deterioration following intravitreal bevacizumab injection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Klein R. Overview of progress in the epidemiology of age-related macular degeneration. Ophthalmic Epidemiol 2007;14:184-7.  Back to cited text no. 1
    
2.
Tufan HA, Gencer B, Kara S. Macular hole after intravitreal bevacizumab injection for choroidal neovascularisation. Clin Exp Optom 2014;97:178-80.  Back to cited text no. 2
    
3.
Bashshur ZF, Haddad ZA, Schakal AR, Jaafar RF, Saad A, Noureddin BN, et al. Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: The second year of a prospective study. Am J Ophthalmol 2009;148:59-650.  Back to cited text no. 3
    
4.
Spaide RF, Laud K, Fine HF, Klancnik JM Jr., Meyerle CB, Yannuzzi LA, et al. Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina 2006;26:383-90.  Back to cited text no. 4
    
5.
Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 2006;113:1695.e1-15.  Back to cited text no. 5
    
6.
Mason JO 3rd, Nixon PA, White MF. Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol 2006;142:685-8.  Back to cited text no. 6
    
7.
Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2006;142:155-8.  Back to cited text no. 7
    
8.
Iliev ME, Domig D, Wolf-Schnurrbursch U, Wolf S, Sarra GM. Intravitreal bevacizumab (Avastin) in the treatment of neovascular glaucoma. Am J Ophthalmol 2006;142:1054-6.  Back to cited text no. 8
    
9.
Jaissle GB, Leitritz M, Gelisken F, Ziemssen F, Bartz-Schmidt KU, Szurman P, et al. One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2009;247:27-33.  Back to cited text no. 9
    
10.
Sato T, Kusaka S, Shimojo H, Fujikado T. Simultaneous analyses of vitreous levels of 27 cytokines in eyes with retinopathy of prematurity. Ophthalmology 2009;116:2165-9.  Back to cited text no. 10
    
11.
Karkhaneh R, Khodabande A, Riazi-Eafahani M, Roohipoor R, Ghassemi F, Imani M, et al. Efficacy of intravitreal bevacizumab for zone-II retinopathy of prematurity. Acta Ophthalmol 2016;94:e417-20.  Back to cited text no. 11
    
12.
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 2012;43:e87-9.  Back to cited text no. 12
    
13.
Moisseiev E, Goldstein M, Loewenstein A, Moisseiev J. Macular hole following intravitreal bevacizumab injection in choroidal neovascularization caused by age-related macular degeneration. Case Rep Ophthalmol 2010;1:36-41.  Back to cited text no. 13
    
14.
Gass JD. Idiopathic senile macular holes: Its early stages and pathogenesis. Arch Ophthalmol 1988;117:744-51.  Back to cited text no. 14
    
15.
Glacet-Bernard A, Voigt M, Coscas G, Soubrane G. Full-thickness macular hole following intravitreal injection of triamcinolone acetonide in central retinal vein occlusion. Retin Cases Brief Rep 2007;1:62-4.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]



 

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