Aflibercept treatment for delayed retinotomy-associated choroidal neovascularization: A case report and literature review

A 67-year-old male presented to our clinic with sudden onset of blurred vision and metamorphopsia of his left eye for 2 weeks. He had a history of combined rhegmatogenous retinal detachment and vitreous hemorrhage and underwent an uneventful pars plana vitrectomy, 360° scleral buckling, and drainage retinotomy for his left eye 3 years ago. The anatomic and visual outcomes after surgery were good, without complications. On examination during this visit, an orange–red subretinal mass connected to the previous drainage retinotomy scar was noted. Spectral-domain optical coherence tomography revealed severe subretinal fluid with type-2 choroidal neovascularization (CNV) mass at the superior nasal macular area in connection with the margin of the previous retinotomy scar. Fundus fluorescein angiography showed an active CNV. The patient underwent monthly intravitreal aflibercept in the left eye. After four doses of aflibercept, his CNV regressed with no recurrence on follow-up at 20 months. In conclusion, iatrogenic CNV is a rare complication following uneventful vitreoretinal surgery and can develop years after the operation. It is crucial to early diagnose and treat it with intravitreal antivascular endothelial growth factor treatment for a favorable outcome and long-term remission.