Full Thickness Macular Hole Surgery After Three Intravitreal Injections of Aflibercept



The pathogenesis of macular hole formation is widely accepted as a tractional force at the vitreo-retinal interface in fovea. Also treatment of macular hole is widely accepted, vitrectomy and ILM peeling. We report a case of macular hole surgery after three intravitreous aflibercept injection as a treatment of that same macular hole. Patient was treated by our colleges from medical retina department, for a hole year, and after third injection was sent to vitreoretinal surgeon for a vitrectomy.

Case presentation:

A 64-year old man with full thickness macular hole affecting his left eye accompanied by a very little cataract was examined for severe vision loss. Although OCT findings were clear at first visit macular hole in his left eye was treated with aflibercept intravitreous injection performed by college from other hospital he received three aflibercept injections as induction treatment. After induction treatment, a full thickness macular hole was “confirmed” with new OCT finding after what patient was sent to vitreoretinal surgeon for macular hole surgery. We have performed phacovitrectomy with ILM peeling and gas tamponade SF6, after which macula closed and visual acuity was restored. Six month after surgery OCT findings shows regular macular morphology and thickness, also visual acuity.


Macular hole is commonly formed associated with tangential vitreous traction. Treatment for full thickness macular hole is widely accepted and it is vitrectomy with ILM peeling and gas tamponade. Current report suggests that rapid growth of intravitreal injections cause more conditions which demands surgical approach. In our case college did recognized conditional but still went for “conservative” therapy. After a year of that therapy it is very difficult for vitreoretinal surgeon to make rational decision to go or not to go for surgery after a wrong therapy for a long period of time (all odds were against surgeon). Doctors from medical retina and vitreoretinal departments are on same mission and should better cooperate for benefit of patients.


Zlatko Musanovic
Tuzla, Bosnia And Herzegovina
Email : zlatkomusan@gmail.com
Cell Phone : 0038761882601
Work Phone : 0038735303250