Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab
A 63-year-old male who had been diagnosed with central retinal vein occlusion in the right eye visited the emergency room with ocular pain and decreased visual acuity. He had been using topical DTFC and brimonidine twice a day for three months because of the IOP elevation after intravitreal injection of triamcinolone acetonid to control the macular edema. With medication, the IOP, OD had been controlled below 20 mmHg for three months. At the time of the emergency room visit, the patient's vision was hand movement, and the IOP was 48 mmHg in the right eye. Slit lamp examination of the right eye disclosed corneal edema and gross hyphema. Iris neovascularization was suspected in the inferior iris although it could not be confirmed due to corneal edema (). Vitreous hemorrhage was also noted in the B-scan ultrasonograph. Subconjunctival injections, 3.75 mg/0.15 mL in total, were completed at the 5, 8, and 11 o'clock areas. One day later, IOP, OD decreased to 32 mmHg, and the cornea was much clearer. Two days after the injections, iris neovascularization was observed only on the margin of the pupil (). The IOP, OD was 29 mmHg.\nWith the conditions much more amicable for surgery, Ahmed glaucoma implant surgery was performed on the right eye on the fourth day after the subconjunctival injections. Preoperative IOP, OD was consistently 29 mmHg. Although the IOP was decreased to 15 mmHg at the next surgery, vigorous iris neovascularization was noted in the inferior iris (). Repeat subconjunctival injections of bevacizumab (1.25 mg/0.05 mL) were performed on this day. Five days after the second injection, the iris neovascularization disappeared completely. Three sessions of PRP were performed during the next three weeks. Three weeks after surgery, the IOP, OD was 17 mmHg, and no neovascularization was visible on the iris ().