Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab
A 62-year-old male presented with decreased visual acuity in his right eye. He was diagnosed with proliferative diabetic retinopathy with concurrent NVG. The best-corrected visual acuity (BCVA) was 20 / 200, OD and 20 / 63, OS. IOPs were 45 mmHg, OD and 14 mmHg, OS, with maximally tolerated medical treatment (topical brimonidine, topical dorzolamide/timolol fixed combination [DTFC], and oral acetazolamide [250 mg, three times a day]). Slit lamp examination revealed active neovascularization in the right eye (). The patient was offered a subconjunctival injection of bevacizumab (Avastin; Genentech Inc., San Francisco, CA, USA) in the right eye. A total of 2.5 mg/0.1 mL of bevacizumab was injected at two locations (7 and 9 o'clock, approximately 1.25 mg/0.05 mL each) using a 26-gauge needle. After the injection, a noticeable bleb was produced. Two days after the injection, the IOP in the right eye was decreased to 21 mmHg. Slit lamp examination revealed a substantial regression of previously visible iris neovascularizations (). On the fourth day after the bevacizumab injections, the IOP in the right eye was 23 mmHg. A remarkable regression of neovascularization was visible. The patient was further treated with three sessions of PRP. Two months after the bevacizumab injections, new vessels were not observed in either the iris or the angle (). However, the IOP was 28 mmHg in the right eye with medication, and Ahmed glaucoma implant surgery was subsequently performed. Two months after the surgery, the IOP was controlled at 12 mmHg without any IOP-lowering medication.