June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Full Thickness Macular Hole Formation after Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy and Diabetic Macular Edema
Author Affiliations & Notes
  • Bilal Farhat
    Ophthalmology, Jamaica Hospital Medical Center, Jamaica, New York, United States
  • Julia P Shulman
    Ophthalmology, Jamaica Hospital Medical Center, Jamaica, New York, United States
  • Jonathan Feistmann
    Ophthalmology, Jamaica Hospital Medical Center, Jamaica, New York, United States
  • Footnotes
    Commercial Relationships   Bilal Farhat, None; Julia Shulman, None; Jonathan Feistmann, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 957. doi:
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    • Get Citation

      Bilal Farhat, Julia P Shulman, Jonathan Feistmann; Full Thickness Macular Hole Formation after Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy and Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):957.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The purpose of this study is to report full thickness macular hole formation in two patients after intravitreal bevacizumab injection for combined proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).

Methods : A retrospective case series on two patients (a 61 year old Hispanic female and 42 year old African American female) being treated with intravitreal bevacizumab for PDR and DME and subsequently developed full thickness macular holes.

Results : The first patient is a 61 year old Hispanic female with extensive neovascularization elsewhere, vitreous hemorrhage and DME in the right eye. The patient underwent one intravitreal bevacizumab injection, panretinal photocoagulation (PRP) and focal laser treatment. One month after the first and only intravitreal bevacizumab in the right eye, a full thickness macular hole developed. The second patient is a 42 year old African American female with PDR and DME in the right eye. Over a 10 month period, she received PRP, focal laser, and three intravitreal bevacizumab injections in the right eye. DME improved but a full thickness macular hole of the right eye formed one month after the last bevacizumab injection. She underwent a pars plana vitrectomy (PPV) with membrane peel and gas tamponade and cataract extraction in the affected eye. At 6 months follow-up, the hole remains open.

Conclusions : Our cases highlight the possibility of macular hole formation with bevacizumab for PDR and DME. We speculate it is related to fibrovascular traction from PDR coupled with the use of the anti-VEGF injection. It is also unclear if surgical repair is less successful in these cases. Further studies are necessary to understand the mechanism of hole formation in these instances as well as the natural history of macular holes post anti-VEGF for PDR and DME.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

61 year old female with full thickness macular hole formation after one intravitreal bevacizumab injection for PDR and DME - preop picture - currently pending surgery.

61 year old female with full thickness macular hole formation after one intravitreal bevacizumab injection for PDR and DME - preop picture - currently pending surgery.

 

42 year old female with full thickness macular hole formation after three intravitreal bevacizumab injections for PDR and DME - post-op picture after PPV with membrane peel and gas tamponade - hole remains open.

42 year old female with full thickness macular hole formation after three intravitreal bevacizumab injections for PDR and DME - post-op picture after PPV with membrane peel and gas tamponade - hole remains open.

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