An unusual optic disc neovascularization in a case of intermediate uveitis associated with multiple sclerosis.
OBJECTIVE
To report a case of intermediate uveitis associated with multiple sclerosis (MS) presenting with a complex of an unusual optic disc neovascularization which was treated successfully.


METHODS
Interventional case report. Best-corrected visual acuity measurements (BCVA), slitlamp examination, fundus biomicroscopy, and fluorescein angiography (FFA) were performed at baseline examination and during the follow-up period. The patient underwent one injection of intravitreal bevacizumab combined with systemic steroids and panretinal photocoagulation.


RESULTS
A 28-year-old man presented with decreased vision in the right eye (RE) (BCVA 20/40). Compete examination showed a large new vessels complex on the optic disc of the RE protruding into the vitreous, ischemic vasculitis, and snowbanking inferiorly. Similar findings but less severe were found in the left eye (LE) with mild vitritis. The RE had also mild, diffuse vitreous hemorrhage. All tests were normal including blood tests, Mantoux, and chest X-ray except brain magnetic resonance imaging which showed three demyelinating lesions. Neurologic evaluation was unremarkable for the first year. The clinical appearance was consistent with intermediate uveitis associated with MS. The patient underwent one injection of intravitreal bevacizumab combined with systemic steroids and panretinal photocoagulation. After 6 months BCVA increased to 20/20 and the neovascular complex became fibrous in RE. The patient, 2 years after treatment, remains stable.


CONCLUSIONS
Intermediate uveitis may precede the diagnosis of MS. Intravitreal bevacizumab combined with systemic steroids and panretinal photocoagulation proved successful in the management of this case.
Karagiannis
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DA
1st Ophthalmology Department of Athens University, Athens - Greece. dimitrioskaragiannis@doctors.org.uk
Ladas
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ID
D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009898:Optic Disk / Q000098:blood supply*; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015867:Uveitis, Intermediate / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab