Macular hole after anti-vascular endothelial growth factor injection: A review

Anti-vascular endothelial growth factor (anti-VEGF) injections are a crucial treatment for neovascular age-related macular degeneration (nvAMD); however, each injection carries the risk of complications, including macular hole (MH) formation. A comprehensive literature search of the PubMed, Embase, and Google Scholar databases identified studies reporting MH formation after anti-VEGF injections for nvAMD. Demographic characteristics included age, sex and affected eye. The presence of intraretinal fluid, subretinal fluid (SRF), pigment epithelial detachment (PED), posterior vitreous detachment, epiretinal membrane, vitreomacular adhesion (VMA), vitreomacular traction (VMT), and retinal pigment epithelial (RPE) tears was recorded. This review includes 15 articles, encompassing 50 eyes. Median patient age was 76.0 years, and 54 % were female. Prior to MH formation, SRF and PED were present in 68 % of eyes. VMA or VMT was observed in 36 % of eyes and the median number of injections before MH development was 3, with a median time to diagnosis of 60 days. While anti-VEGF is an essential therapy, clinicians must be aware of the risk of MH Predisposing factors including PEDs, VMT, and significant intra- or subretinal fluid, should be considered. Further research is needed to fully understand the mechanisms and explore preventative strategies.