Choroidal neovascular membrane (CNVM) is most commonly encountered as a manifestation of wet age-related macular degeneration; however, secondary CNVM may occur following trauma, inflammation, or surgical insult to the retina. Development of CNVM following vitreoretinal surgery is rare, and its occurrence secondary to iatrogenic retinal touch has been infrequently reported.1 This photo essay illustrates a rare case of CNVM emerging from an iatrogenic macular injury sustained during vitreoretinal intervention for a dropped nucleus. A 50-year-old female underwent phacoemulsification for cataract, which was complicated by posterior capsular rupture with inferior nucleus drop. Pars plana vitrectomy with phacofragmentation followed by retro-pupillary intraocular lens implantation was performed. During the vitreoretinal procedure, an inadvertent instrument touch occurred in the macular region, sparing the foveal center. The immediate postoperative period was uneventful, and the patient maintained stable vision. One year later, evaluation of the operated eye revealed an iatrogenic macular scar with an associated CNVM located inferior to the fovea Figure 1. Spectral-domain optical coherence tomography through the lesion demonstrated a hyperreflective subretinal scar with disruption of the retinal pigment epithelium (RPE)–Bruch’s membrane complex, consistent with a scarred CNVM without evidence of activity Figure 2. As there were no signs of clinical or tomographic activity, the patient was advised regular six-monthly follow-up.Figure 1: Left eye fundus picture showing scar (black arrow) with choroidal neovascular membrane (blue arrow) inferior to foveaFigure 2: Left eye optical coherence tomography scan: Hyper-reflectivity in sub-retinal pigment epithelium space (blue arrow) denoting the neovascular complexCNVM develops following the disruption of Bruch’s membrane and/or the RPE, permitting choroidal vascular proliferation into the sub-RPE or subretinal space.2 Direct mechanical injury during surgery may initiate a reparative inflammatory response, resulting in upregulation of vascular endothelial growth factor and subsequent neovascularization.3 In the present case, intraoperative accidental instrument touch leading to an iatrogenic retinal break was the most significant contributing factor. Postoperative inflammation and oxidative stress induced by vitreoretinal surgery may further compromise RPE integrity, facilitating CNVM development.4,5 Similar mechanisms have been proposed in previous reports of iatrogenic CNVM following macular surgery.1,3 What is already known CNVM may develop following the disruption of Bruch’s membrane secondary to trauma or macular surgical procedures. What is new This photo essay highlights the emergence of CNVM arising from an iatrogenic macular touch during vitreoretinal surgery for a dropped nucleus, documented using optical coherence tomography. Data availability statement Data supporting the findings of this study are available from the corresponding author upon reasonable request. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for her images and clinical information to be reported in the journal. The patient understands that her name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Ranga et al. (Wed,) studied this question.