Angle-Closure Attack After Retinal Pigment Epithelium Double-Tear And Hemorrhagic Retinal Detachment In Exudative Macular Degeneration

Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient's intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition.Conclusions: It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.