Macular hole overlying pigment epithelial detachment after intravitreal injection with ranibizumab.

PURPOSE: To describe a previously unrecognized complication of intravitreal injection in a patient with exudative macular degeneration and vitreomacular adhesion. METHODS: Case report of a 69-year-old woman. RESULTS: One month after intravitreal injection with ranibizumab for exudative macular degeneration, our patient developed a full-thickness macular hole with visual acuity of 20/100. After pars plana vitrectomy with membrane peeling and fluid-gas exchange, the macular hole was closed and the visual acuity improved to 20/60. CONCLUSIONS: Macular hole formation after intravitreal injection with ranibizumab is a potential complication that should be considered before treatment, especially in those patients with large subfoveal pigment epithelial detachments and vitreomacular adhesion. Although successful closure may be attained after pars plana vitrectomy, this potential morbidity should be considered when treating these patients. In addition to the already well-described tractional forces of the vitreous overlying the fovea, and the potential contractile nature of a choroidal neovascular complex in response to ranibizumab, a posterior pushing or stretching mechanism of a large pigment epithelial detachment may also contribute to macular hole formation.