Be Wary of Macular Hole After Anti-VEGF Injection
This complication, although rare, is still possible.
Carlos Mario Rangel, MD; Karol Quintero Lizcano, MD; Maria Isabel Corrales, MD; Maria A. Piedrahita, MD; and Virgilio Galvis, MD
Retina Today 
KEY TAKEAWAYS Despite their overall excellent safety profile, anti-VEGF injections can, rarely, lead to serious adverse effects. The authors present a case of a patient who developed a full-thickness macular hole (FTMH) following a course of anti-VEGF intravitreal injections for macular edema secondary to combined central retinal artery and vein occlusion. It is important to acknowledge that development of a FTMH is a known risk in patients with chronic macular edema, such as the one in this case. Intravitreal anti-VEGF injections are a mainstay of treatment for many retinal conditions, including wet AMD, macular edema following retinal vein occlusion (RVO), diabetic macular edema, diabetic retinopathy, and myopic choroidal neovascularization.1,2 Despite their overall excellent safety profile, anti-VEGF injections can, rarely, lead to serious adverse effects, including endophthalmitis, rhegmatogenous retinal detachment, RVO, and others.2 Development of a full-thickness macular hole (FTMH) has also been described, which is likely secondary to the severe contraction of the neovascular membrane and focal vitreoretinal traction forces induced by the anti-VEGF agent.3-9 Here, we present our case of a patient who developed a FTMH following a course of anti-VEGF intravitreal injections for macular edema secondary to combined central retinal artery and vein occlusion (CCRAVO). CASE EXAMPLE A 54-year-old man presented with a 1-month history of vision loss in his right eye. His corrected distance VA (CDVA) was counting fingers at 2 m OD and 20/25 OS, and his IOP was 14 mm Hg OU. No abnormalities were observed in the anterior segment of either eye. Fundus examination of his left eye was normal, while his right eye revealed intraretinal hemorrhages and venous engorgement in all four quadrants demonstrating macular whitening (ischemic retinal edema) consistent with central retinal artery occlusion, as well as a “cherry-red spot” or foveal-sparing and peripheral intraretinal hemorrhages typical of central RVO (Figure 1). These findings were consistent with a diagnosis of CCRAVO.10 Figure 1. OCT and OCTA at baseline showing hyperreflective inner layers, subretinal fluid, and macular edema, with reduced vascular density in both the superficial and deep plexuses.
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