Ranibizumab
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Retinal pigment epithelium tear and lamellar macular hole evolving to full-thickness macular hole: case report An 86-year-old woman developed retinal pigment epithelium tear and lamellar macular hole evolving to full-thickness macular hole during treatment with ranibizumab for neovascular age-related macular degeneration (nAMD). The woman, who had bilateral nAMD, received six intravitreal injection of ranibizumab [Lucentis] in the right eye (RE) and ten injection in the left eye (OS) on pro re nata regimen. Visual acuity (VA) in the RE was 20/200 and in the OS was 20/100. Spectraldomain optical coherence tomography (SD-OCT) demonstrated pigment epithelium detachment (PED) with subretinal fluid and cystoid macular oedema in OS. Hence, she was started on treatment with new intravitreal injection of ranibizumab in OS. Four weeks after the treatment, she reported of central scotoma with VA impairment (20/400). SD-OCT demonstrated retinal pigment epithelium tear with lamellar macular hole. Well-delimited denuded area of retinal pigment epithelium was noted. Ultra-wide field autofluorescence demonstrated hypo-autofluorescence of the same denuded area. Hence, the woman’s intravitreal therapy with ranibizumab was stopped. Two months later, the lamellar macular hole evolved in to a full-thickness macular hole. At 5 year long-term follow-up, an enlargement of retinal pigment epithelium and subretinal hyperreflective area was observed due to increased fibrosis. Color retinography showed macular fibrosis with retinochoroidal anastomosis and central hyperpigmentation. Ultra-wide field autofluorescence demonstrated enlargement of the lesion with an increase in hyper-autofluorescence area due to progression of macular degeneration. Her VA acuity remained the same. Moll-Udina A, et al. Simultaneous retinal pigment epithelium tear and lamellar macular hole evolving to a full-thickness macular hole after intravitreal injection. Journal 803515450 Francais d’Ophtalmologie 43: e237-e239, No. 7, Sep 2020. Available from: URL: http://doi.org/10.1016/j.jfo.2019.11.010
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Reactions 14 Nov 2020 No. 1830
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