| 본문 : Choroidal neovascularization (CNV) development after ERM removal is very rare, with only seven reported cases. We encountered one case of iatrogenic CNV following vitrectomy for ERM peeling in which intravitreal aflibercept injection resulted in successful CNV regression.
A 74-year-old woman presented with decreased vision and metamorphopsia of the right eye. The best-corrected visual acuity (BCVA) was 20/200 and 20/25 in the right and left eyes, respectively. Fundus examination showed ERM in the right eye. The patient underwent pars plana vitrectomy with membrane removal without intraoperative complications. Four weeks after surgery, the BCVA was 20/130 in her right eye and the ERM was successfully removed. However, she still complained of blurred vision in the right eye. Juxtafoveal CNV was found on fundus examination and was confirmed by fluorescein angiography and optical coherence tomography (OCT). Given the diagnosis of CNV, intravitreal aflibercept injections were applied in the right eye three times at four-week intervals, and one more injection was administered two months after the third injection. At one year after surgery, the CNV had regressed without recurrence, and the BCVA in the right eye had improved to 20/100.
The cause of CNV formation and its relationship to ERM removal has not been clearly elucidated. We propose that trauma during surgery, such as retinal pigment epithelium (RPE) and Bruch’s membrane disruption, is the most likely cause of CNV for several reasons. First, iatrogenic CNV secondary to ERM peeling is usually located in the parafoveal spaces where the ERM was located, as observed in this patient and in other reported cases, while CNV associated with age-related macular degeneration (AMD) generally occupies the macular region. Second, CNV occurred within one month after operation in our case.
CNV after ERM removal is treated similarly to CNV from other etiologies. In our case, repeated aflibercept injections resulted in successful CNV regression and improved vision. Further investigation with more patients and long-term follow-up is required.
In conclusion, secondary CNV is an uncommon complication following successful surgery for ERM. Surgeons should be aware of this complication, as timely diagnosis and treatment are required to prevent visual deterioration. |