Acute vision loss after intravitreal injection of bevacizumab (avastin) associated with ocular ischemic syndrome.
OBJECTIVE
To report a patient with diabetic rubeosis who suffered from acute retinal ischemic change and stroke after intravitreal injection of bevacizumab.


METHODS
A 55-year-old man had diabetes with unilateral rubeosis and macular edema. Three days after receiving intravitreal injection of bevacizumab (1.25 mg in 0.1 ml), he developed acute vision loss and change of consciousness. A complete ocular examination, fluorescein angiography, carotid artery Doppler sonography and brain magnetic resonance imaging were performed.


RESULTS
Best corrected visual acuity before injection was 6/60 in the left eye. He had underlying left carotid artery stenosis combined with bilateral preproliferative diabetic retinopathy. Three days after intravitreal injection of bevacizumab, acute ocular ischemic syndrome occurred. He also suffered from acute stroke, and brain magnetic resonance angiography showed total left internal carotid artery occlusion. The final visual acuity was no light perception in the left eye and 3/6 in the right eye.


CONCLUSIONS
Patients receiving intravitreal injections of bevacizumab should be evaluated for potential systemic risk factors such as carotid insufficiency, coagulopathy and poorly controlled diabetes mellitus. Acute ocular ischemic change may be associated with intravitreal injection of bevacizumab in patients with vascular compromised diabetic retinopathy and/or underlying stenosis of the carotid artery.
Huang
Zei-Lun
ZL
Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC.
Lin
Kung-Hung
KH
Lee
Yuan-Chieh
YC
Sheu
Min-Muh
MM
Tsai
Rong-Kung
RK
D000208:Acute Disease; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D001766:Blindness / Q000139:chemically induced*; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005451:Fluorescein Angiography; D015355:Glaucoma, Neovascular / Q000188:drug therapy; D006801:Humans; D007267:Injections; D007511:Ischemia / Q000139:chemically induced* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012171:Retinal Vessels / Q000187:drug effects*; D020521:Stroke / Q000139:chemically induced / Q000175:diagnosis; D013577:Syndrome; D018608:Ultrasonography, Doppler; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab