Author: Mehmet Citirik (Turkey)
Co-authors: Ayse Gul Kocak Altintas, Selda Celik Dulger
Purpose
To describe a case of branch retinal vein occlusion (BRVO) after vitrectomy for a full-thickness macular hole (FTMH).
Setting/Venue
Description of a clinical case of a patient followed in Ophthalmology Consult - Ophthalmology Department of the University of Health Science, Ankara Ulucanlar Eye Education and Research Hospital, Turkey.
Methods
A 71-year-old woman admitted to the ophthalmology department with progressive, vision loss in her left eyes for 1 month. She had a history of hypertension for 15 years. She did not report any trauma. The best-corrected visual acuity was 20/25 in her right eye and 20/40 in the left. Intraocular pressures with applanation were 13 mmHg OD and 14 mmHg OS respectively. Anterior segment examinations of both eyes showed an intraocular lens in the posterior chamber. Funduscopy revealed an image of an FTMH that was confirmed by Spectralis® SD-OCT (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany). The patient underwent a 25-gauge vitrectomy with complete removal of the posterior hyaloid. Classic internal limiting membrane (ILMM) peeling was accomplished with the aid of brilliant blue solution (Brilliant Blue G, ILM Blue; Dorc International, Zuidland, The Netherlands). Fluid-air exchange was carried out and air in the vitreous cavity was replaced with 14% perfluoropropane (C3F8) gas. No intraoperative complications were seen during the surgery. The patient was instructed to maintain a prone position for 5 days after surgery.
Results
On the first postoperative week, BCVA was 20/1250 for the left eye, and dilated fundus examination revealed that the partial closed macular hole under the gas as flu. Intraocular pressures with applanation were 12 mmHg OD and 15 mmHg OS respectively. Control examination was recommended at 1st month and 2nd months later, but the patient could not come in the first month. At the 2nd month's follow-up, BCVA improved to 20/40, and fundoscopy and OCT revealed a completely closed macular hole. Besides, mild hemorrhage and edema were observed in the inferior temporal trace. Fluorescein angiography of the left eye demonstrated the leakage points throughout the fovea. Fundus autofluorescence showed mildly increased autofluorescence. Spectral-domain optical coherence tomography demonstrated the mild-moderate cystoid macular edema in an outer and inner nuclear layer at the macula. Three dose bevacizumab treatment was performed monthly. Cystoid macular edema disappeared at the macula and the visual acuity of the right eye increased to 20/30 four weeks after three doses of treatment. During the 12 months follow-up, recurrent cystoid macular edema was not observed, also the macular hole continued to remain closed.
Conlusions
Macular holes and their results are well defined in the surgical literature. However, there is a lack of evidence regarding the approach to branched retinal vein occlusion. These results suggest that three-dose bevacizumab may be a potentially effective therapeutic option for patients with retinal vein occlusion associated with the macular hole that is causing deterioration in vision.
Financial Disclosure
None
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