Choroidal Neovascularization Following Epiretinal Membrane Peeling

Dear Editor, Although surgical removal of the epiretinal membrane (ERM) in symptomatic patients is frequently performed and provides quite good anatomical and functional results, ERM peeling often causes complications such as cataract formation in phakic eyes, retinal tear or detachment, and macular edema [1]. Choroidal neovascularization (CNV) development after ERM removal is very rare, with only seven reported cases [2]. We encountered one case of iatrogenic CNV following vitrectomy for ERM peeling in which intravitreal af libercept injection resulted in successful CNV regression. We report this case with a literature review. 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. She had previously undergone bilateral cataract surgery at another clinic. Fundus examination showed ERM in the right eye (Fig. 1A-1D). 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. Extrafoveal CNV was found on fundus examination and was confirmed by fluorescein angiography and optical coherence tomography (Fig. 1E-1H). Given the diagnosis of CNV, intravitreal af libercept (Eylea, Bayer Pharma AG, Berlin, Germany) 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 af ter surgery, the CNV had regressed without recurrence (Fig. 1I-1L), and the BCVA in the right eye had improved to 20 / 100. The cause of CNV formation and its relationship to ERM removal have not been clearly elucidated. We propose that trauma during surgery, such as retinal pigment Korean J Ophthalmol 2015;29(6):439-440 http://dx.doi.org/10.3341/kjo.2015.29.6.439