Intravitreal bevacizumab for retinal neovascularizations associated with myelinated nerve fibers.

PURPOSE: To report the effects of intravitreal bevacizumab injection (IVBI) in a patient affected by retinal neovascularizations (RNVs) associated with myelinated nerve fibers (MNF) and complicated by vitreous hemorrhage. METHODS: A 23-year-old female was referred because of sudden visual acuity deterioration in the left eye. Nine years earlier, the subject underwent retinal laser photocoagulation for recurrent vitreous hemorrhages related to the development of RNV associated with MNF. The ophthalmological evaluation revealed a new recurrence of vitreous hemorrhage associated with fluorescein leakage from RNV. After careful discussion, the patient underwent IVBI. RESULTS: One month after the injection, the best corrected visual acuity (BCVA) improved from 20/400 to 20/100, with a vitreous hemorrhage resolution, and cessation of fluorescein leakage. Over the 24-month follow-up, 2 additional IVBIs were administered due to further vitreous hemorrhage associated with fluorescein leakage from RNV, achieving a final BCVA of 20/80. CONCLUSIONS: IVBI may temporarily counteract the vascular hyperpermeability typical of RNV associated with MNF, leading to the cessation of fluorescein leakage, but does not result in RNV regression.

Triple therapy for corneal neovascularization: a case report.

PURPOSE: To investigate the effect of the combination of photodynamic therapy with verteporfin and subconjunctival bevacizumab and triamcinolone acetonide on corneal neovascularization secondary to corneal graft failure. METHODS: A patient with extensive deep and superficial corneal neovascularization underwent same day triple therapy with subconjunctival bevacizumab (1.25 mg), subconjunctival triamcinolone acetonide (40 mg), and photodynamic therapy with verteporfin (fluence 50 J/cm², irradiance 300 mW/cm²). RESULTS: A complete angiographic new vessel regression was obtained and was discernible starting 7 days after combination therapy. Three months after treatment, an initial new-vessel sprout was noted. Triple therapy was then repeated. No angiographic evidence of corneal neovascularization was detectable for the entire 6-month follow-up duration. CONCLUSIONS: Triple therapy may offer a promising tool in the treatment of corneal neovascularization.

Sequential anterior ischemic optic neuropathy and central retinal artery and vein occlusion after ranibizumab for diabetic macular edema.

PURPOSE: To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME). METHODS: A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 µm. In July 2009, BCVA dropped to 20/100 with CRT of 421 µm due to the recurrence of DME and a further injection was administered. RESULT: One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins. CONCLUSIONS: Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.