First Author: A.A.Ivanescu UK
Co Author(s): I. Akram D. Assheton A. Tin-u 0 0 0 0 0 0 0 0 0
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To report the case of a traumatic macular hole immediately after the last intravitreal ranibizumab injection for the treatment of choroidal neovascularization (CNV) which spontaneously healed rapidly.
Ophthalmology department. St Helens Hospital and and Knowsley NHS Trust.
A seventy nine year-old woman contacted the eye department one day after the last intravitreal injection in her left eye complaining of a reduction in her central vision which started two hours after the injection. A next day appointment was arranged. She had a previous history of end stage wet macular degeneration in her right eye and CNV in her left eye treated with twelve intravitreal ranibizumab injections. Forty eight hours after the intravitreal injection an examination confirmed a decrease in the visual acuity of only thirty seven letters compared to seventy five letters before the injection. An OCT scan was performed which revealed a full thickness macular hole. Urgent cataract surgery was planned previous to pars plana vitrectomy with an additional internal limiting membrane peeling.
One month later the examination revealed successful spontaneous closure of the macular hole with an improvement in the visual acuity at sixty letters. Both cataract and vitrectomy surgeries were cancelled.
Macular hole is a rare potential complication after intravitreal ranibizumab injection. After reviewing the literature we found that a macular hole usually occurs months after the intravitreal injection. We believe that this is the first case of a macular hole which happened immediately after intravitreal ranibizumab injection. Furthermore, spontaneous closure has been described but usually takes a few months to show recovery rather than weeks, like in our case. Overall we propose that patients who undergo an intravitreal injection should be carefully maintained and followed up for possible complications such as full thickness macular hole. We believe that our case is an extremely rare and interesting case in both time of occurrence and resolution.