Abstract
BACKGROUND Branch retinal vein occlusion (BRVO) is a common cause of vision loss in older adults, and cystoid macular edema (CME) is its most frequent vision-threatening complication. Depending on severity, vitreomacular traction (VMT) is typically managed with observation or surgery. When CME develops during observation (e.g., in BRVO), the therapeutic approach becomes more complex. Anti-vascular endothelial growth factor (VEGF) therapy is a standard treatment for CME secondary to BRVO. Although full-thickness macular hole (FTMH) formation is rare, it has been reported in eyes with preexisting VMT, suggesting a contributory role for tractional forces. CASE REPORT A 72-year-old woman under observation for VMT developed BRVO with CME. Baseline optical coherence tomography revealed VMT, an epiretinal membrane, a lamellar macular hole, and a vertical hyperreflective line at the fovea resembling the "foveal crack sign". The patient received an intravitreal faricimab injection to achieve rapid edema resolution with fewer injections. CME improved; however, an FTMH subsequently developed, accompanied by a decline in best-corrected visual acuity to 20/33. The patient then underwent combined vitrectomy and cataract surgery, which achieved successful hole closure. CME recurred postoperatively but responded well to a second faricimab injection, resulting in visual recovery to 20/22. CONCLUSIONS FTMH may develop after anti-VEGF therapy in eyes with preexisting VMT. This appears to be the first reported case following faricimab treatment for BRVO-associated CME, underscoring the need for careful pretreatment evaluation of the vitreoretinal interface and awareness of potential tractional complications. Individualized treatment strategies may help reduce such risks and improve outcomes.