title: Full thickness macular hole case after intravitreal aflibercept treatment.
abstract: BACKGROUND
  The pathogenesis of macular hole formation is widely accepted as a tractional force at the vitreo-retinal interface in fovea. We report a case of macular hole after intravitreous aflibercept injection for age-related macular degeneration (AMD) associated with contraction of the retinal pigment epithelium (RPE) at the edge of a fibrovascular pigment epithelial detachment (PED).
  
  
  METHODS
  A 94-year old man with neovascular AMD affecting his left eye accompanied by a fibrovascular PED was examined for severe vision loss. Although RPE tear in his left eye was identified before the first aflibercept intravitreous injection performed in order to treat neovascular AMD, he received three aflibercept injections as induction treatment. After induction treatment, a full thickness macular hole was identified associated with the contracted rolled RPE edge beneath the retina.
  
  
  CONCLUSIONS
  Macular hole is commonly formed associated with tangential vitreous traction. Current report suggests that rapid contraction of the RPE underneath the retina can be one of the causes of a macular hole, and one of the side effects of anti-VEGF therapy for neovascular AMD.
authors.affiliation: Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yuji@eye.med.kyushu-u.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA. Apte@vision.wustl.edu.
authors.forename: Rajendra S
authors.initials: RS
authors.lastname: Apte
authors.affiliation: Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. snakao@med.kyushu-u.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yosida@mailserver.med.kyushu-u.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. ishi@eye.med.kyushu-u.ac.jp.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishibashi
mesh_terms: D000369:Aged, 80 and over; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008266:Macula Lutea / Q000187:drug effects / Q000473:pathology*; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage / Q000009:adverse effects*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects*; D012167:Retinal Perforations / Q000139:chemically induced / Q000175:diagnosis*; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor