A Case of Acute Anterior Uveitis Associated with HLA-B27 Positivity after Intravitreal Injection of Bevacizumab

PURPOSE: Intravitreal injection of bevacizumab (Avastin(R)) can lead to several intraocular complications including endophthalmitis, hemorrhage and inflammation. We present one case of acute anterior uveitis with hypopyon in an HLA-B27(+) patient following intravitreal injection of bevacizumab. CASE SUMMARY: A 40-year-old male with known central retinal vein occlusion presented with redness and decreased visual acuity in the left eye. Symptoms had developed 4 days earlier after the sixth intravitreal injection of bevacizumab in that eye. The patient had a marked anterior chamber reaction with hypopyon and posterior synechiae. Nine days after onset, similar symptoms in the left eye occurred in the uninjected right eye. Through examination and clinical manifestations, we diagnosed acute anterior uveitis associated with HLA-B27 positivity. The patient was treated with 1% prednisolone acetate, 0.5% moxifloxacin and 1% atropine in both eyes and all symptoms had resolved after 6 weeks.

Clinical Studies in Patients with HLA-B 27 Positive Uveitis

It is well known that HLA-B 27-associated uveitis is mostly anterior uveitis and has systemic manifestations.20 Patients [27 eyes]followed up at department of Ophthalmology of Kangnam St.Mary`s hospital, Catholic University Medical College from November 1989 to June 1998, were studied to delineate the clinical manifestations, treatments and prognosis in patients with HLA-B 27-associated uveitis.An HLA B27 associated systemic disorder was present in 10 patients, all of whom were ankylosing spondylitis. Systemic manifestations occurred in 19 patients included oral ulcer in 7 patients, genital ulcer in 3 patients, arthralgia in 16 patients, and skin lesion in 3 patients.Among the total 27 eyes, anterior uveitis was noted in 23 eyes and posterior segment involvement occurred in 4 eyes.The findings of posterior segment involvement included retinal vasulitis in 2 eyes and chorioretinitis in 1 eyes.Severe vitritis occurred in 1 eyes.Most of anterior uveitis was treated with topical steroid eyedrops and periocular steroid injections.In 3 eyes of posterior segment involvement, systemic steroid therapy was required for control of inflammation.After treatment, visual acuity in 23 eyes among 27 eyes was 20/40 or better.And, visual acuity in 4 eyes of posterior segment involvement was 20/25 or better following medical treatment.In conclusion, although HLA-B 27-associated uveitis was mostly related to anterior uveitis, posterior segment manifestations may be occurred in some patients;these patients may require the use of aggressive systemic immunosuppressive therapy to control inflammation and preserve vision.