title: Macular hole formation in the presence of a pigment epithelial detachment after three consecutive intravitreal antivascular endothelial growth factor injections.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the development of a macular hole (MH) and vitreomacular attachment (VMA) after treatment of a subfoveal pigment epithelial detachment (PED) by 3 consecutive antivascular endothelial growth factor (VEGF) injections in a patient with age-related macular degeneration (AMD).
  
  
  METHODS
  A 67-year-old woman with a subfoveal PED and occult choroidal neovascularization received 3 consecutive intravitreal ranibizumab injections in her left eye. Her initial visual acuity (VA) was 20/30.
  
  
  RESULTS
  Her VA stabilized at 20/30 at 3 months after the last injection; however, cross-sectional scans using optical coherence tomography (OCT) demonstrated a small vitreous attachment on the retinal surface at the foveola. Two months later, her VA was decreased to 20/100, and on biomicroscopy there was a positive Watzke sign on the center of the PED. OCT disclosed an increased VMA with a full-thickness MH. The perpendicular retina was elevated, whereas the PED appeared stabile.
  
  
  CONCLUSIONS
  Consecutive intravitreal injections may alter the vitreous gel, thus inducing a posterior vitreous detachment or VMA. New symptoms after the uploading phase with decreased VA or metamorphopsia may not necessarily relate to a progression of the AMD, but may also relate to a novel incomplete posterior vitreous vitreomacular traction possibly triggering the formation of traction and MH formation.
authors.affiliation: Department of Ophthalmology, University of Bonn, Bonn, Germany.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Clemens
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
authors.forename: Carsten H
authors.initials: CH
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D010857:Pigment Epithelium of Eye / Q000473:pathology; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000139:chemically induced*; D012167:Retinal Perforations / Q000139:chemically induced*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab