Isolated Scleral Dehiscence After Repeated Intravitreal Aflibercept Injections

Hypotony Maculopathy Related to Anti-VEGF Intravitreal Injection

Purpose

To describe a case of hypotony maculopathy following anti-VEGF intravitreal injection (IVI) in a patient with pseudoxanthoma elasticum (PE).

Methods

Clinical case report.

Results

A 52-year-old male complained of right eye (OD) vision loss 2 days after an uncomplicated anti-VEGF IVI for the treatment of choroidal neovascularization secondary to angioid streaks. Relevant medical history included PE, pathologic myopia, and a previous pars plana vitrectomy (PPV) due to a retinal detachment. OD best-corrected visual acuity (BCVA) dropped from 6/12 to 6/18 after the IVI. Intraocular pressure (IOP) was 3 mmHg and chorioretinal folds were evident in the posterior pole. Topical dexamethasone and atropine were prescribed, and full recovery was noticed after 3 days. Four months later, the patient developed a new episode of vision loss after another IVI. His BCVA was counting fingers, IOP was 2mmHg, and more noticeable chorioretinal folds were found. This time, an open scleral wound at the injection site was evident and a scleral suture was necessary. Once again, the patient recovered well.

Conclusion

Hypotony maculopathy following intravitreal injection is a rare condition. However, the described patient presented several conditions which could be related with poor scleral wound closure: intrinsic scleral fragility due to myopia and pseudoxanthoma elasticum; repeated IVI procedures; and absence of vitreous in the posterior segment due to prior vitrectomy. Despite the good outcome, hypotony maculopathy may be a sight-threatening condition, and special attention is necessary for specific patients with risk factors.

Recurrent Tube Erosions with Anti-Vascular Endothelial Growth Factor Therapy in Patients with Age-Related Macular Degeneration

PURPOSE

To determine the rates of primary and recurrent glaucoma tube shunt erosions in patients with age-related macular degeneration (AMD) receiving anti-vascular endothelial growth factor (VEGF) intravitreal injections.

DESIGN

Retrospective case series.

PARTICIPANTS

Patients with AMD who underwent tube revision for erosion at the Duke Eye Center from January 1, 1999, to January 1, 2019, were identified. Patients with and without anti-VEGF injections were compared.

METHODS

Patient demographics, ocular diagnoses, glaucoma tube shunt types and locations, and dates of glaucoma surgeries and anti-VEGF injections were collected. Statistical analyses were performed with P < 0.05 as significant.

MAIN OUTCOME MEASURES

Outcome measures included the number of tube erosions, time from anti-VEGF injection to tube erosion, and secondary complications after tube revisions.

RESULTS

A total of 150 patients with AMD with anti-VEGF (309 tubes) and 262 patients with AMD without anti-VEGF (459 tubes) were identified. There was no statistically significant difference in the number of tube erosions in patients with anti-VEGF (15 tubes, 4.8%) versus without anti-VEGF (12 tubes, 2.6%) (P = 0.10). However, patients receiving anti-VEGF had on average a greater number of tube erosion events (2.1±0.7 events) compared with patients without anti-VEGF (1.3±0.7, P < 0.01). Ten patients (91%) received concurrent anti-VEGF injections at the time of tube erosion, and the average duration of prior anti-VEGF therapy was approximately 2 years. Tube erosion was noted 46.5±60.7 days from the preceding anti-VEGF injection. Secondary complications after tube revision in the anti-VEGF group included 5 explanted tubes for recurrent erosions.

CONCLUSIONS

Our results suggest intravitreal anti-VEGF injections are linked to higher rates of recurrent glaucoma tube erosions in patients with AMD. The majority of patients received chronic and serial anti-VEGF injections. Thus, additional consideration should be given to glaucoma surgical planning in patients receiving anti-VEGF injections, especially in those with a primary tube erosion.