First Author: J.Montero-Moreno SPAIN
Co Author(s): A.A. Merino-Iglesias J.M. Ruiz-Moreno J. Ruiz-Medrano I. Flores-Moreno 0 0 0 0 0 0 0 0 0
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To report the appearance of macular holes in patients treated by intravitreal bevacizumab in exudative age related macular degeneration (AMD) and the predisposing spectral domain optical coherence tomography (SD OCT) pattern.
Single centre, retrospective, interventional study.
The clinical files and fluorescein angiogram and OCT imaging of patients with choroidal neovascularization secondary to AMD treated by intravitreal bevacizumab were revised.
Two male patients with macular holes after intravitreal treatment were identified. Both patients presented subfoveal choroidal neovascularization (CNV) and had been previously treated by intravitreal bevacizumab and ranibizumab for exudative AMD. The OCT patterns prior to the appearance of the macular hole were identical in both patients with a flat plateau in the foveal area, roughly similar to a lamellar hole. During the re-activation of CNV subretinal fluid developed under this flat area. One month after intravitreal injection of bevacizumab was performed a complete macular hole was observed, even though the patients did not report decreased visual acuity. Macular holes occurred after 4 and 1 injections of bevacizumab respectively. Best-corrected visual acuity (BCVA) previous to the formation of the macular hole was 4/10 and 1/20, improving to 4/8 and 4/32 respectively one month later. Surgery and prone positioning was discussed with the patients and rejected, and monthly intravitreal injections were continued. BCVA 12 months after the formation of the macular hole was 4/25 and 4/20.
Macular hole may occur in patients with exudative AMD treated by intravitreal bevacizumab that can be associated with maintained BCVA without vitreous surgery. In these cases the appearance of macular hole seems to be associated with the presence of subretinal fluid as well as a weaker retinal structure and can be triggered by the injection of intravitreal anti vascular endothelial growth factor.