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Ophthalmic Images
October 10, 2019

Isolated Scleral Dehiscence After Repeated Intravitreal Aflibercept Injections

Author Affiliations
  • 1Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
  • 2Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York
JAMA Ophthalmol. 2019;137(10):e185935. doi:10.1001/jamaophthalmol.2018.5935

A man in his early 80s with neovascular age-related macular degeneration in his right eye presented with a new spot on his eye. The patient had been receiving monthly intravitreal aflibercept injections over 2 and a half years (30 total injections) and had no known autoimmune history. His visual acuity was 20/200 OD, and he had a 1.5-mm circular scleral dehiscence 3 mm inferotemporal to the limbus (Figure, A). Ultrasonography confirmed full-thickness scleral defect plugged by chorioretinal tissue (Figure, B, arrowhead). Blood cell count and metabolic panel results were normal with no evident inflammatory markers. Test results for antineutrophil cytoplasmic, treponemal, Lyme, antinuclear, and herpetic IgM antibodies as well as interferon-gamma release assay were negative. Gram stain and culture did not show white blood cells or bacteria. Scleroplasty and ocular surface reconstruction closed the defect. Occult traumatic rupture of the sclera (typically posterior to muscle insertion)1 and necrotizing scleritis after surgical procedures2 have each rarely been reported. The relationship of an isolated anterior scleral dehiscence with intravitreous hyperemia, or an occult autoimmune disorder, cannot be determined from this one case.