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Case Reports
. 2024 Nov 12:24741264241297684.
doi: 10.1177/24741264241297684. Online ahead of print.

Antivascular Endothelial Growth Factor Injections for the Chronic Treatment of Macula-off, Fovea-on Diabetic Tractional Retinal Detachment With Vitreous Hemorrhage

Melissa Yuan  1 , Sandra Hoyek  1 , Leo A Kim  1 , Celine Chaaya  2 , Nimesh Patel  1
Affiliations
Case Reports

Antivascular Endothelial Growth Factor Injections for the Chronic Treatment of Macula-off, Fovea-on Diabetic Tractional Retinal Detachment With Vitreous Hemorrhage

Melissa Yuan et al. J Vitreoretin Dis. .

Abstract

Purpose: To evaluate the use of antivascular endothelial growth factor (anti-VEGF) as treatment for tractional retinal detachments (TRDs) involving the macula. Methods: A case report was evaluated. Results: A 40-year-old man with a medical history notable for congenital heart disease and proliferative diabetic retinopathy presented with decreased vision. Surgery was not feasible for medical reasons, and panretinal photocoagulation was limited by retinal traction and hemorrhage. Despite initial progression of bilateral macula-off, foveal-on TRDs, the patient received intravitreal (IVT) bevacizumab regularly every 8 to 12 weeks. After initial improvement, both eyes remained anatomically stable with attached foveas over more than 1.5 years of follow-up. Conclusions: In cases in which surgery is not possible, macula-involving TRDs with neovascularization can be managed successfully with repeated IVT anti-VEGF injection monotherapy.

Keywords: antivascular endothelial growth factor; surgery; tractional retinal detachment.

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Conflict of interest statement

Although the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article, the following declared financial disclosures: Dr. Patel is a consultant to Regeneron, Dutch Ophthalmic, Genentech, EyePoint Pharmaceuticals, and Alcon Vision. Dr. Kim is a consultant to Ingenia Therapeutics and CureVac AG, receives research support from CureVac AG and Valo Health, and receives grant support from the National Eye Institute (R01EY027739) and US Department of Defense (VR220059). None of the other authors declared potential conflicts of interest with respect to the research, authorship, and/or publication of the article.

Figures

Figure 1.
Figure 1.
Fundus photographs from the patient’s initial presentation. (A) The right eye shows vitreous hemorrhage with some partially visible fibrovascular proliferation. (B) The left eye shows neovascularization (NV) of the disc, NV elsewhere, hemorrhages, and fibrovascular proliferation along the arcades. Optical coherence tomography (OCT) of the left eye shows an attached fovea with some diabetic macular edema and traction in the superior macula. (C) View through the fovea. (D) View through the superior macula. The OCT image quality of the right eye was poor because of the presence of vitreous hemorrhage and is not shown.
Figure 2.
Figure 2.
(A) Fundus photograph of the right eye 1 month after incomplete vitrectomy. (B) Optical coherence tomography (OCT) of the right eye shows improvement 1 month postoperatively, at which time intravitreal (IVT) bevacizumab is given, stabilizing the eye. (C) After being lost to follow-up for 1 year, the patient presented again with reattachment of the fovea, although some traction continued to affect the inferior macula. (D) Approximately 3 months later, the patient received IVT bevacizumab at an outside hospital. Five months after the patient returned after loss to follow-up (2 months after IVT bevacizumab), a focal tractional retinal detachment is seen in the inferior macula but the macula is attached. He has subsequently received regular IVT bevacizumab in the right eye, and his examinations remained stable. OCT 3 months (E), 5 months (F), and 14 months (G) after the patient returned after loss to follow-up.
Figure 3.
Figure 3.
(A) Fundus photograph of the left eye 1 month after partial panretinal photocoagulation (PRP) of the left eye. (B) One month after partial PRP, optical coherence tomography (OCT) shows improvement, then stability. (C) After being lost to follow-up for 1 year, the patient presented with reattachment of the fovea. (D) About 3 months later, the patient received intravitreal (IVT) bevacizumab at an outside hospital. Five months later (2 months after IVT bevacizumab), the patient presented again, with superior and inferior tractional retinal detachments and an attached fovea. He has subsequently received regular IVT bevacizumab in the left eye, with his examinations remaining stable. OCT 3 months (E), 5 months (F), 7 months (G), and 14 months (H) after the patient returned after loss to follow-up.
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