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.