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Tractional retinal detachment (‘crunch’ phenomenon) from intravitreal anti-vascular endothelial growth factor injection in central retinal vein occlusion
  1. Albert John Bromeo,
  2. Amadeo Veloso,
  3. Sweet Jorlene Lerit and
  4. Myron Carlo Gomez
  1. Asian Eye Institute, Makati City, Philippines
  1. Correspondence to Dr Albert John Bromeo; albert.bromeo{at}


Tractional retinal detachment is an uncommon complication of intravitreal anti-vascular endothelial growth factor (VEGF) injection wherein the drug triggers tractional retinal detachment as a result of fibrovascular membrane contraction. We present a case of a 42-year-old hypertensive woman diagnosed with chronic central retinal vein occlusion on both eyes. The right eye had total retinal detachment and neovascular glaucoma, while the left eye had retinal neovascularisation. Panretinal photocoagulation and intravitreal anti-VEGF injection was started on the left eye. However, she was lost to follow-up. She returned 4 months later with extensive tractional retinal detachment involving the macula on the left eye. She subsequently underwent vitrectomy with endolaser and silicone oil tamponade on the left eye. The anti-VEGF ‘crunch’ results from regression of fibrovascular proliferation with a concurrent increase in fibrosis, resulting in worsening retinal traction. With the widespread use of anti-VEGF agents, ophthalmologists need to be aware of this vision-threatening complication.

  • ophthalmology
  • retina
  • macula

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  • Contributors AJB, AV, SJL and MCG provided substantial contributions to the conception or design of the work and acquisition, analysis or interpretation of data for the work. AV, MCG and AJB were directly involved in the management of the patient. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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