Iatrogenic posterior retinal break from intravitreal anti-VEGF injection in a vitrectomized eye.

Purpose: To describe a case of a perforating fluid stream of aflibercept resulting in an iatrogenic retinal break with possible subretinal infiltration using a pre-filled syringe (PFS).

Methods: History, examination, fundus photography, and SD-OCTs.

Results: A 60-year-old female with diabetic macular edema (DME) OU was treated with intravitreal aflibercept (IVA) injections with a PFS. She developed a macular hole (MH), which was repaired with vitrectomy surgery. She required ongoing IVA injections after her MH surgery. Two days following an injection, the patient returned complaining of flashes, floaters, and a red linear streak in her vision. Visual acuity (VA) declined from 20/150 OS to 20/250. Examination showed an iatrogenic posterior retinal break with hemorrhage and edema. Fundus photography, fluorescein angiography and OCT imaging were obtained. After two weeks of observation, the defect had closed. After five weeks, VA returned to 20/150 OS. She resumed IVA injections using PFS.

Conclusions: This case presents a potential complication in vitrectomized patients receiving intravitreal injections.