Bilateral macular hole after anti-vascular endothelial growth factor therapy in a patient with exudative age-related...

To report a case of bilateral nonsequential macular holes that developed after intravitreal ranibizumab therapy for treatment of exudative age-related macular degeneration.

A 76-year-old man presented with sudden vision loss in the right eye initially followed by the left eye 1 year later. Initial fundoscopic examination showed a subretinal hemorrhage in the right eye and dry macular degeneration in the left eye. Initial optical coherence tomography and fluorescein angiogram confirmed the diagnosis of subfoveal choroidal neovascularization in the right eye. There was no evidence of vitreofoveal traction. The patient was treated with intravitreal injections of ranibizumab (0.5 mg). One year later, choroidal neovascularization developed in his left eye as well.

After choroidal neovascularization regression, full-thickness macular holes were observed in both eyes. Pars plana vitrectomy with internal limiting membrane removal was performed in both eyes. Anatomic closure of the macular hole in the left eye without significant vision improvement occurred but the right macular hole remained open despite the surgery.

Exudative age-related macular degeneration can be a precursor to macular hole formation.