CHOROIDAL NEOVASCULARIZATION AFTER MACULAR PLUG SURGERY

To report choroidal neovascularization (CNV) after macular plug surgery for full-thickness macular hole, detailing four cases-two postinverted internal limiting membrane flap and two posthuman amniotic membrane (hAM) procedures.

Retrospective, observational small case series. Multimodal imaging investigation comprising optical coherence tomography, optical coherence tomography angiography, and fluoroscein angiography/indocyanine angiography of CNVs after macular plug surgery.

In all cases, CNV affected the fovea, with two cases occurring in refractory macular holes and two in primary idiopathic macular holes. Choroidal neovascularizations in inverted flap cases showed high exudative and fibrotic potential with limited response to antivascular endothelial growth factor treatment. In hAM implantation cases, one CNV remained contained within the hAM, while the other exhibited late leakage near the hAM without exudation on optical coherence tomography. Three cases displayed type 2 CNV, while one showed a mixed CNV pattern. Visual acuity ranged from 20/120 to 20/200. The study categorized these lesions as CNV in plug surgery because of their unique pathogenesis.

Choroidal neovascularization occurring after inverted internal limiting membrane flap surgery with a fill variant shares characteristics such as foveal involvement and poor visual outcomes, likely because of high exudative activity and fibrosis. These findings highlight the need for careful monitoring of CNV in patients undergoing macular plug surgery, particularly those using the inverted internal limiting membrane flap technique. Moreover, we describe the development of CNV inside hAM in the context of peri-hAM atrophy after successful refractory macular hole surgery, without exudative properties beyond the hAM.