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TitleSpontaneous close of diabetic macular edema related macular hole after intravitreal Eylea injection
PurposeTo report early formation of a full-thickness macular hole that developed after vitrectomy in a patient with epiretinal membrane (ERM) related diabetic macular edema (DME) and spontaneous closure after intravitreal aflibercept injection (IAI).
MethodsCase report.
ResultsA 36 y/o man presented with blurred vision OS. Best-corrected visual acuity (BCVA) was 6/6 OD and 6/15 OS. Fundus examination revealed non-proliferative diabetic retinopathy OU and macular pucker OS. Optical coherence tomography disclosed ERM with vitreopapillary traction, diffuse DME, lamellar macular hole and retinoschisis OS. Fluorescein angiography showed leaking microaneurysms with cystoid macular edema OS. The lamellar hole closed but macular edema persisted after intravitreal ranibizumab injection. Trans pars plana vitrectomy with membrane peeling, internal limiting membrane peeling, endolaser and sulfur hexafluoride (SF6) infusion were performed. The patient kept face-down position for 2 weeks. The macular edema improved but a full-thickness macular hole was noted 6 weeks later. After twice intravitreal aflibercept injection, the macular edema improved and the macular hole closed spontaneously. The BCVA improved to 6/8 at the final visit 1 year later.
ConclusionDiffuse DME unresponsive to anti-VEGF treatment may be associated with vitreopapillary traction. Macular hole may occur when peeling the ERM and ILM in eyes with cystoid macular edema with a thin inner retinal wall. Improvement of DME after intravitreal aflibercept injection may enhance the spontaneous closure of full-thickness macular hole.
Conflict of interestNo
Author 1
Last nameWU
Initials of first name(s)JS
Author 2
Last nameChen
Initials of first name(s)SN