Hemolytic Glaucoma Following Intravitreal Aflibercept Injection for Age-Related Macular Degeneration: A Case Report.

BACKGROUND Intraocular pressure (IOP) elevation secondary to intraocular hemorrhage after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for age-related macular degeneration (AMD) is exceedingly rare. Although mild, transient hyphema has been reported, secondary glaucoma caused by hemolysis or ghost cell formation has not previously been documented in this setting. CASE REPORT A 54-year-old man presented with decreased vision and was diagnosed with exudative AMD in the right eye. Baseline evaluation showed subretinal hemorrhage and macular neovascularization, and intravitreal aflibercept injections were initiated and continued for 1 year. Three days after the tenth injection, the patient developed blurred vision, progressing to hand-motion vision by day 4. Slit-lamp examination revealed hyphema with a fluid level, and IOP increased to 50 mmHg despite conservative therapy. The patient underwent anterior chamber irrigation and phacoemulsification with pars plana vitrectomy. Intraoperatively, mild vitreous hemorrhage was observed, and temporal scleral indentation revealed a localized blood clot adherent to the pars plana and vitreous base at the injection site. Postoperatively, IOP normalized, without recurrence of vitreous hemorrhage or exudative activity during 1-year follow-up. CONCLUSIONS This case demonstrates that hemolytic glaucoma can develop even after intravitreal anti-VEGF injection in AMD, a context in which intraocular bleeding is uncommon. Clinicians should remain vigilant to postinjection IOP elevation, and timely surgical intervention can yield favorable visual and pressure outcomes.