This 37YO female presented with a symptomatic diabetic traction retinal detachment (TRD) extending from the peripheral macula towards the mid-peripheries. Vision was 20/60. An intravitreal Avastin injection was given in preparation for vitrectomy within the week.
However, due to work-related reasons, the patient delayed the surgery and returned 2 weeks later, complaining of several days of increasing distortion and vision loss. Vision was 20/200. There was marked fibrosis of all neovascularization, and the macula was now detached. Vitrectomy was scheduled within the next several days.
Learning Points:
Intravitreal anti-VEGF is commonly used before diabetic vitrectomies to cause rapid involution of the vascularized preretinal tissue and control intraoperative bleeding during membrane dissection. These injections are given within a week of surgery since the neovascularization can contract with increased traction. This uncommon but known phenomenon is called the ‘crunch’ syndrome.
See Tan et al for a recent crunch review (Survey of Ophthalmology 2021;66:926-932).
