\r\nMaterials and Methods: A 77-year-old male initially received three loading doses of intravitreal bevacizumab, followed by ongoing intravitreal aflibercept therapy as needed. Clinical findings, optical coherence tomography (OCT) images, and surgical outcomes were retrospectively evaluated.

\r\nResults: Before the 17th aflibercept injection, OCT revealed a pigment epithelial detachment (PED), subretinal fluid, an epiretinal membrane (ERM), and vitreomacular traction (VMT) associated with a tightly adherent posterior hyaloid. One month after the injection, a full-thickness macular hole (FTMH) developed. The patient underwent pars plana vitrectomy with ERM and internal limiting membrane peeling and 14% C₃F₈ gas tamponade. Postoperatively, the macular hole was closed, and the best-corrected visual acuity (BCVA) improved from 0.1 to 0.3. As the PED and subretinal fluid persisted, anti-VEGF therapy was continued.

\r\nConclusion: FTMH development during anti-VEGF therapy is rare but may occur, particularly in the presence of VMT or ERM. Detailed pre-injection OCT evaluation and close follow-up of high-risk patients enable timely surgical intervention and preservation of anatomical integrity. Keywords : Age-related macular degeneration, Anti-VEGF therapy, Aflibercept, Full-thickness macular hole, Vitreomacular traction