Introduction:  The benefit of immediate focal photocoagulation for diabetic macular edema was demonstrated in the Early Treatment Diabetic Retinopathy Study (ETDRS). Anti-vascular endothelial growth factor (VEGF) therapy have been focused as alternative or adjunct treatments. We report a case of a patient who developed lamellar macular hole, one month after intravitreal pegaptanib sodium injection for diabetic macular edema.

Materials and Methods:  Interventional case report.

Results:  A 66 – year-old patient with type 2 diabetes presented in the right eye a cystoid diabetic macular edema, without clinically detectable vitreomacular traction. One injection of pegaptanib 0.05 ml/0.3 mg was administered without complication. One month after intravitreal pegaptanib sodium injection (0.05 ml/0.3 mg), the patient presented no visual acuity improvement and complained of newly developed metamorphopsia. Fundus biomicroscopy and OCT revealed deep reduction of the cystoid macular edema, with lamellar macular hole formation, characterized by visibly detached posterior hyaloid, roof of the cyst above the macula, and foveal photoreceptors layer intact below the area of foveal dehiscence.

Discussion:  Despite a lamellar hole could result from the degenerative process associated with cystoid macular edema, the pathogenesis of lamellar macular hole can be attributed in our case to the intravitreal injection, which may have induced vitreous incarceration, causing a vitreoretinal traction at the macula and the development of a lamellar macular hole. Alternatively or in association, pegaptanib itself may have caused the lamellar macular hole by inducing a sudden reduction of the diabetic macular edema and hence, the exacerbation of tangential traction of the posterior vitreous on the overlying macular retina. On the other hand, in our patient, we were not able to detect any other potential causes, such as epiretinal membrane formation and/or contraction, after the intravitreal pegaptanib injection.

Conclusion:  Lamellar macular hole seems to be a potential complication of pegaptanib injection, even in patients without pre treatment clinically detectable vitreo-macular traction.