Multiple serous retinal detachments after Anti-VEGF Intravitreal Injection for pachychoroid related choroidal neovascularization

To describe a case of serous retinal detachment (SRD) resembling Vogt Koyanagi-Harada (VKH) disease following anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) for pachychoroid related choroidal neovascularization (CNV). A 23-year-old female complained of vision loss in her right eye (OD) one day after receiving an anti-VEGF IVI for CNV. Her best-corrected visual acuity (BCVA) in OD dropped from 20/40 to 20/200, and intraocular pressure (IOP) measured 9 mmHg. The IVI resulted in development of hypotony maculopathy, manifesting as evident chorioretinal folds. Notably, there was significant increase in choroidal thickness and dilation of choroidal vessels. Multiple SRD were observed, and fundus fluorescein angiography (FFA) findings resembled those seen in VKH. Topical and systemic steroids were prescribed to prevent inflammation, resulting in an increase in IOP and improvement in choroidal thickness and SRD. Pachychoroid spectrum diseases (PSD) is associated with alterations in pachyvessel permeability and RPE damage. Hypotony maculopathy following IVI for PSD can manifest as SRD, with FFA findings resemble VKH. Careful monitoring of IOP and vigilance regarding scleral wound integrity at the injection site are imperative after IVI procedures in patients with PSD.