title: Acute vision loss after intravitreal injection of bevacizumab (avastin) associated with ocular ischemic syndrome.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Zei-Lun
authors.initials: ZL
authors.lastname: Huang
authors.forename: Kung-Hung
authors.initials: KH
authors.lastname: Lin
authors.forename: Yuan-Chieh
authors.initials: YC
authors.lastname: Lee
authors.forename: Min-Muh
authors.initials: MM
authors.lastname: Sheu
authors.forename: Rong-Kung
authors.initials: RK
authors.lastname: Tsai
mesh_terms: 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
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab