Macular Laceration Following Intravitreal Injection in a Nanophthalmic Eye: Management with Pars Plana Vitrectomy.

PURPOSE: To report a case of macular laceration following intravitreal injection in a nanophthalmic eye and its surgical management.

METHODS

A nanophthalmic patient presented with visual decline after intravitreal bevacizumab injection. Multimodal imaging demonstrated a full-thickness macular defect, vitreous hemorrhage, and epiretinal membrane (ERM), consistent with suspected needle-induced injury. Following failed medical therapy, 27-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed using modified sclerotomy placement.

RESULTS

Surgery was successfully completed with treatment of an intraoperative peripheral retinal break. At 3.5 months, visual acuity improved from hand movements to 20/80. Optical coherence tomography confirmed ERM resolution, retinal reattachment, and restoration of macular architecture without cystoid macular edema or uveal effusion.

CONCLUSION

Macular laceration is a rare but potentially vision-threatening complication of intravitreal injection, with increased risk in anatomically crowded eyes such as nanophthalmos. Careful surgical planning allows successful vitrectomy with favorable anatomical and visual outcomes in this high-risk population.