Microbubble in the hole: a rare cause of failed macular hole surgery?

PURPOSE: To present a failed macular hole surgery with gas microbubble retention within the hole. METHODS: A 68-year-old female patient with a Stage 2 macular hole underwent vitrectomy with removal of posterior hyaloid and 12% C3F8 gas injection. Because the macular hole was Stage 2 and posterior hyaloid was observed to be firmly attached over the macular area, no attempt was made for peeling of internal limiting membrane. Postoperatively, the patient was instructed to keep a facedown posture for 1 week. At 1-month visit, ophthalmoscopy revealed a tiny gas bubble filling the macular hole that failed to close. RESULTS: The patient underwent a repeat vitrectomy in which internal limiting membrane was peeled, and the eye was filled with 20% SF6. At 2-week follow-up visit, the hole was observed to be closed. CONCLUSION: The reason for the macular hole nonclosure in this case may be the lack of internal limiting membrane peeling in the first operation. However, the authors believe that microbubble localized within the hole might have contributed to the failure.

Short-term effects of a single intravitreal bevacizumab injection on retinal vessel calibre.

PURPOSE: The aim was to investigate the short-term effects of a single intravitreal bevacizumab injection on the retinal vessel calibre in patients with neovascular age-related macular degeneration and in patients with diabetic macular oedema. METHODS: Twelve patients with neovascular age-related macular degeneration and eight patients with diabetic macular oedema were included in the study. All patients received an intravitreal injection of 1.25 mg bevacizumab. Red-free fundus photographs (35°) were acquired with a fundus camera at baseline and one day, one week and one month after the intravitreal injection. Measurements of retinal vessel diameter were made of the supero-temporal retinal venule and arteriole using the software available on the IMAGEnet program. RESULTS: Although there appeared to be a trend towards vasoconstriction for the measurements in the diabetic macular oedema group (both for arterioles and venules at day 7) and the age-related macular degeneration group (for venules at day 1 and for arterioles at day 7), it did not reach statistical significance (p > 0.05). Optical coherence tomography revealed a significant decrease in foveal thickness measurements in both groups at the one month visit compared with baseline. CONCLUSION: The results suggest that intravitreal injection of bevacizumab might induce retinal vasoconstriction; however, low numbers of subjects might have prevented the difference from reaching statistical significance. Further studies with a larger number of subjects would reveal the effect of intravitreal anti-vascular endothelial growth factor treatment on retinal vessel diameters more clearly.

A case of sterile endophthalmitis after repeated intravitreal bevacizumab injection.

PURPOSE: The aim of this study was to describe a case of sterile endophthalmitis after repeated intravitreal bevacizumab injections for the treatment of choroidal neovascularization secondary to angioid streaks. METHODS: This study was done as a case report. RESULTS: A 57-year-old man who received a third injection of intravitreal bevacizumab for the treatment of choroidal neovascularization owing to angioid streaks developed sterile endophthalmitis. The patient's condition improved after hourly topical steroid and antibiotic drops without a sequele. CONCLUSIONS: The intravitreal injection of bevacizumab has the potential for the development of sterile endophthalmitis. The patients should be warned against this possible adverse reaction, especially after repeated injections.