Macular Pseudohole (MPH) Formation Following Intravitreal Injection of Bevacizumab (Avastin): 3 Cases

Abstract

Purpose: : to report 3 cases of macular pseudoholes development in patients undergone intravitreal injection of Bevacizumab.

Methods: : 3 patients (70 years old, 56 years old and 82 years old) affected respectively by diabetic macular edema (DME), cystoid macular edema (CME) after branch retinal vein occlusion (BRVO) and choroidal neovascolarization (CNV) in Age-Related Macular Degeneration (AMD), were treated with repeated intravitreal injection of Bevacizumab 1.25mg, monthly for 3 months. Before surgery every patients underwent a complete eye examination including optical coherence tomography (OCT) and fluorescein angiography (FA). The same protocol was repeated 1 month after the last intravitreal injection of Bevacizumab.

Results: : in all the 3 eyes no clinical and anatomical evidence of epiretinal membrane or vitreo-macular traction was observed before intravitreal injection. OCT showed a pseudohole (MPH) development in 1 case and a lamellar macular hole (LMH) in 2 eyes with epiretinal membrane. OCT showed a characteristic profile: a steepened foveal pit combined with thickened foveal edges and the simoultaneous presence of epiretinal membrane. No additional complications were reported.

Conclusions: : OCT could be useful in detecting MPH attributable to epiretinal membrane contraction from lamellar macula holes because of partial opening of a macular cyst. The intravitreal presence of anti-Vascular Endothelial Growth Factor could be implicated in the switch from anti-angiogenetic effect to fibrosis.

Keywords: macular holes • macula/fovea • injection