Treatment of Co-existent Occult Choroidal Neovascular Membrane and Macular Hole

The co-existence of a macular hole and a choroidal neovascular membrane can represent a diagnostic and therapeutic dilemma. In this noncomparative case report, we report on a patient with co-existent macular hole and choroidal neovascular membrane. The patient initially was found to have an occult choroidal neovascular membrane. The patient was not treated and the vision remained stable for almost 1 year until the patient noted further visual decline. The patient was treated with intravitreal pegaptanib and the patient's vision remained stable for 6 months. However, on follow-up the patient presented with visual decline and a full thickness macular hole was confirmed by optical coherence tomography (OCT). The patient underwent repair and vision improved with closure of the macular hole. The occult choroidal neovascular membrane remained stable with no evidence of disease progression. Fundus photos, intravenous fluorescein angiograms, and OCT were obtained before and after therapy and confirmed the diagnosis. This report highlights how the detection of co-existent macular hole and choroidal neovascular membrane may require OCT scanning. When treatment is entertained, therapy should be directed first toward the neovascular complex and then to repair the macular hole.