Intravitreal ziv-aflibercept for myopic macular neovascularization after pars plana vitrectomy and silicone oil tamponade: a case report

Introduction and importance: Myopic macular neovascularization (mMNV) is a significant complication of pathological myopia, leading to vision impairment. The primary treatment involves anti-VEGF therapy, with ziv-aflibercept emerging as a cost-effective alternative to traditional therapies. However, the presence of silicone oil in the vitreous cavity, often used in complex vitreoretinal surgeries, poses challenges for drug delivery. This case report aims to explore the efficacy of intravitreal ziv-aflibercept in treating mMNV in a silicone oil-filled eye. Case presentation: A 66-year-old woman with a history of high myopia underwent vitrectomy and silicone oil tamponade. She presented with significantly reduced visual acuity. Spectral-domain optical coherence tomography (SD-OCT) imaging revealed mMNV, subretinal fluid, and signs of hypotony in her right eye. Given these findings, the patient was administered an intravitreal injection of ziv-aflibercept. Clinical discussion: Post-injection, the patient exhibited marked improvements, including enhanced visual acuity improving to counting fingers at a distance of 2 m and decreased intraocular pressure to 6 mmHg. SD-OCT imaging demonstrated resolution of subretinal fluid, indicating successful treatment of mMNV. These positive outcomes were maintained over a follow-up period of 6 months, suggesting that ziv-aflibercept can effectively manage mMNV even in the presence of silicone oil. Conclusion: Intravitreal ziv-aflibercept injection is a viable early treatment option for patients with mMNV in silicone oil-filled eyes. This case highlights its potential to achieve mMNV regression and improve visual acuity, thereby preventing irreversible vision loss in affected individuals. Further studies are warranted to establish standardized protocols for its use in similar clinical scenarios.