First Author: M.Cuesta SPAIN
Co Author(s): J. Barbon Garcia L. Fernandez Presa C. Vina Escalar V. Abelairas Gomez
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To report the clinical and optical coherence tomography (OCT) findings in an eye with diffuse macular edema that developed macular fibrosis after intravitreous anti-VEGF treatment.
Department of Opthalmology Hospital San agustin, Avilés, Asturias, Spain
A 70 years old diabetic man was presented in 2014 to gradually decreased visual acuity in her left eye (OS). On Snellen chart best corrected visual acuity (BCVA) was 6/10 in her right eye (OD) and 5/10 in OS. Fundus examination and optical coherence tomography (OCT) revealed diabetic retinopathy with diffuse diabetic macular edema in OS while focal edema in OD. Treatment with intraocular ranibizumab injections was suggested.
In the next five months three ranibizumab injections were administered in OS, which were followed by Eylea® injections for incomplete response. After one month since the first OS Eylea® injection (four doses of anti-VEGF in total) massive lipid accumulation appeared on foveal area, at the same time that macular edema slightly decreased. After another five Eylea® injections macular edema was entirely resolved. However, hard exudates on macular area were replaced by intraretinal fibrosis. Colour images and OCT showed lipid deposit evolution to fibrosis and resolution of edema with dome-sharp hyperreflective area corresponding to fibrosis. Visual acuity was severe decreased in OS eye (BCVA <1/10).
This case report shows an exceptional complication, an extensive macular fibrosis in diffuse diabetic macular edema after anti-VEGF therapy.