Macular hole retinal detachment after intravitreal Conbercept injection for the treatment of choroidal neovascularization secondary to degenerative myopia: a case report
verfasst von:
Chuan-bin Sun , Yueye Wang, Shiyang Zhou, Xudong Fang, Danni Xu, Zhe Liu
We report a case of macular hole (MH) formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization (CNV) secondary to degenerative myopia.
Case presentation
A 60-year-old woman presented with blurred vision in her left eye was diagnosed as CNV secondary to degenerative myopia. Intravitreal injection of conbercept, an anti -vascular endothelial growth factor (VEGF) agent, was uneventfully performed in the left eye. Unfortunately, a full thickness MH and retinal detachment was found three weeks postoperatively by ophthalmoscopy and spectral-domain optical coherence tomography. Vitrectomy, internal limiting membrane peeling and silicone oil tamponade were then performed, and macular retina was reattached soon after surgery. However, MH still kept open during three months’ follow-up.
Conclusion
MH is a quite rare complication of intravitreal anti- VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.
Hinweise
Dr. Fang XD and Xu DN are trainees
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
AMD
Age-related macular degeneration
BCVA
Best corrected visual acuity
CNV
Choroidal neovascularization
MH
Macular hole
SD-OCT
Spectral-domain optical coherence tomography
VEGF
Vascular endothelial growth facto
Background
Choroidal neovascularization (CNV) is characteristic of many sight-threating fundus diseases such as exudative age-related macular degeneration (AMD), polypoidal choroidal vasculopathy, myopic CNV, and idiopathic CNV [1‐3]. Recently, intravitreal anti-vascular endothelial growth factor (VEGF) agents have successfully improved the treatment outcome and visual prognosis of CNV. However, macular hole (MH) formation has emerged to be a new challenging adverse effect of intravitreal anti-VEGF agent therapy for CNV, which was mostly reported in anti-VEGF therapy for exudative AMD cases [3‐13].
We herein present a case of MH formation and retinal detachment after intravitreal conbercept injection for the treatment of CNV caused by degenerative myopia.
Anzeige
Case presentation
A 60-year-old woman complained of blurred vision in her left eye for one week. On presentation, the best corrected visual acuity (BCVA) was 0.6 in the right eye, and hand motion in the left eye. Slit lamp examination revealed normal anterior segment in both eyes. Direct ophthalmoscopy revealed slight macular epiretinal membrane in the right eye, and grey submacular membrane surrounded by subretinal hemorrhage in the left eye (Fig. 1a). The axial length of the right eye was 30.61 mm, and that of the left eye was 30.43 mm by IOL Master measurement. Fundus fluorescein angiography revealed early-staged submacular hyperfluorescence lesion (Fig. 1b), followed by strong fluorescein leakage and enlargement of hyperfluorescence in the later phases (Fig. 1c). Indocyanine green angiography demonstrated early-staged clustered hyperfluorescence spots (Fig. 1d), which showed evident leakage and enlargement in the later phases (Fig. 1e), confirming an active CNV in the left eye. Spectral-domain optical coherence tomography (SD-OCT) revealed type 2 CNV surrounded by serous neurosensory macuar detachment and intraretinal cysts above CNV in the left eye (Fig. 1f). Her past medical history was not remarkable. CNV secondary to degenerative myopia in the left eye was then diagnosed and uneventful intravitreal conbercept (2.5 mg/0.05 ml) injection was performed soon after the informed consent was signed.
×
Three weeks after the injection, the patient came back with a complaint of central scotoma in the left eye. BCVA was counting fingers, funduscopic examination revealed a full thickness MH and surrounded retinal detachment (Fig. 2a), SD-OCT comfirmed a full thickness MH accompanied by macular detachment and intraretinal cysts in the left eye (Fig. 2b). Vitrectomy, internal limiting membrane peeling assisted by indocyanine green staining, and silicone oil tamponade were successfully performed in the left eye. Postoperative SD-OCT at one week’s follow-up revealed a reattached macular retina yet still open MH in the left eye. At three months’ follow-up, BCVA in the left eye was 0.05, MH still kept open depite successful macular reattachment and Fuchs spot formation (Fig. 2c, d) which was characterized by a hyperreflective subretinal spot in SD-OCT.
×
Discussion and conclusions
MH is a rare yet sight threating complication of intravitreal anti-VEGF agent injection [3‐13]. Our literature research based on Pubmed database revealed that there were only dozens of cases who developed a full thickness MH after intravitreal injection of anti-VEGF angents which were mostly involved with ranibizumab and bevacizumab, and occasionally with aflibercept [3‐15]. To our knowledge, this is the first case report of MH formation after intravitreal conbercept injection.
Our report about conbercept-induced MH formation, together with previous case reports of other anti-VEGF agents (such as ranibizumab, bevacizumab, and aflibercept) induced MH formation, provides an important insight into the pathogenesis of MH formation after anti-VEGF therapy in eyes with CNV, and reveals that MH formation would be caused by anti-VEGF effect rather than the other characteristics of anti-VEGF agents such as molecular weight, pH, and three- dimensional structure. This finding is of great importance in helping CNV patients to choose an appropriate anti-VEGF agent.
Anzeige
The exact pathogenesis of MH formation after intravitreal injection of anti-VEGF angents is still under discussion. Shrinkage and regression of CNV induced by anti-VEGF agents could cause centrifugal tangential contraction, this contraction probably led to tractional forces to foveal neural retina, and finally developed a full thickness MH [4, 5, 11‐15]. In this case, CNV tissue was positioned centrally beneath fovea before intravitreal conbercept injection, yet the regressed CNV tissue (Fuchs spot) was located at one edge of the MH after conbercept injection, which implied that the tangential contraction caused by the shrinked CNV might be the main mechanism of MH formation in CNV cases with intravitreal anti-VEGF agent injection. Many previous literature reports showed similar findings which strongly supported our speculation [4, 5, 11‐15].
Although MH formation after intravitreal anti-VEGF agent injection is quite rare, it should be kept in mind that such complication might occur after intravitreal injection of any anti-VEGF agent. CNV Patients should be warned about this potential complication, and it should also be included in the differential diagnosis when CNV lesions did not show any therapic response to or even deteriorated after anti-VEGF agent therapy [4, 5, 13, 15].
In conclusion, MH is a quite rare complication of intravitreal anti-VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.
Acknowledgments
The authors would like to acknowledge the funding support of the Administrative Bureau of Traditional Chinese Medicine of Zhejiang Province (No. 2015ZA055).
Ethics approval and consent to participate
Institutional review board approvals were obtained from both Second Affiliated Hospital of Zhejiang University School of Medicine and Zhejiang Provincial People’s Hospital. This study was conducted according to the tenets of the Declaration of Helsinki. Informed consents were obtained from all participants.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.
Competing interests
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Macular hole retinal detachment after intravitreal Conbercept injection for the treatment of choroidal neovascularization secondary to degenerative myopia: a case report
verfasst von
Chuan-bin Sun Yueye Wang Shiyang Zhou Xudong Fang Danni Xu Zhe Liu
Die Verwendung von Ophthalmika in der Schwangerschaft und Stillzeit stellt immer eine Off-label-Anwendung dar. Ein Einsatz von Arzneimitteln muss daher besonders sorgfältig auf sein Risiko-Nutzen-Verhältnis bewertet werden. In der vorliegenden …
Die endogene Endophthalmitis ist eine hämatogen fortgeleitete, bakterielle oder fungale Infektion, die über choroidale oder retinale Gefäße in den Augapfel eingeschwemmt wird [ 1 – 3 ]. Von dort infiltrieren die Keime in die Netzhaut, den …
Eine endogene Endophthalmitis stellt einen ophthalmologischen Notfall dar, der umgehender Diagnostik und Therapie bedarf. Es sollte mit geeigneten Methoden, wie beispielsweise dem Freiburger Endophthalmitis-Set, ein Keimnachweis erfolgen. Bei der …
Die bestmögliche Wundheilung der Kornea, insbesondere ohne die Ausbildung von lichtstreuenden Narben, ist oberstes Gebot, um einer dauerhaften Schädigung der Hornhaut frühzeitig entgegenzuwirken und die Funktion des Auges zu erhalten.
Update Augenheilkunde
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.