Occult choroidal neovascularization after successful macular hole surgery treated with ranibizumab

Ha Na Oh,1 Joo Eun Lee,2 Hyun Woong Kim,1 Jae Wook Yang,1 Il Han Yun11Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea; 2Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, KoreaPurpose: To report on a case that developed an atypical form of occult choroidal neovascularization (CNV) after successful macular hole surgery.Methods: Visual acuity change, color fundus photographs, fluorescein and indocyanine green angiograms, and optical coherence tomography results were compared throughout the follow-up duration.Patients: A 64-year-old woman with a macular hole in the right eye and drusen in both eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. One month after the operation she developed occult CNV, in which pigment epithelial detachment and fine retinal pigment epithelial (RPE) layer wrinkles were observed under the completely sealed macular hole. After 3-monthly intravitreal injections of ranibizumab, the lesion did not change significantly.Conclusion: CNV can develop after otherwise successful macular hole surgery, especially in patients with pre-existing aging changes in the macula, such as drusen. Care should be taken in such patients, to prevent the development of CNV after macular hole surgery.Keywords: drusen, macular hole surgery, occult choroidal neovascularization, ranimizumab injectio