Supplementary Material for: Unexpected Vision Loss Following Six Intravitreal Injections for Neovascular Age-Related Macular Degeneration

Introduction
We present a case of a patient with preceding vitreomacular traction who developed a full thickness macular hole (FTMH) following his sixth intravitreal aflibercept injection for the treatment of age-related macular degeneration (AMD), and to review the literature on risk factors and pathogenesis of this adverse event.

Case Presentation
FTMH can occur after an extended number of repeat intravitreal injections in the setting of worsening vitreomacular adhesion (VMA) or vitreomacular traction (VMT). This patient’s FTMH was successfully treated surgically in a timely manner and additional injections were resumed safely.

Conclusions
Patients with an unexpected decrease in vision after intravitreal injections should be re-evaluated with optical coherence tomography to rule out alternative pathology including vitreomacular interface abnormalities. FTMH, if present, should be treated promptly to allow for resumption of therapy as needed and visual optimization.