Intravitreal triamcinolone and bevacizumab therapy for combined papillophlebitis and central retinal artery occlusion.
OBJECTIVE
To report a case of an idiopathic, unilateral combined central retinal artery and vein occlusion in a young, healthy patient successfully treated with combined intravitreal triamcinolone and bevacizumab injection.


METHODS
Interventional case report. A 38-year-old man presented with a 2-hour history of acute painless loss of vision in his right eye. Ophthalmic examination revealed count fingers visual acuity, an afferent pupillary defect, a discreet cherry red spot, optic disk edema, and scattered intraretinal hemorrhages in the right fundus. Fluorescein angiography confirmed the central retinal artery occlusion diagnosis.


RESULTS
A standard treatment for central retinal artery occlusion and a combined intravitreal triamcinolone and bevacizumab injection were performed. An exhaustive laboratory workup failed to reveal any evidence of systemic vascular, inflammatory, or hypercoagulable disorders. Transesophageal echocardiography, carotid Doppler, and magnetic resonance imaging of the orbits and brain were all unremarkable. In the month after initiation of the treatment, the patient's visual acuity gradually improved to 20/30 and remained stable during a 12-month follow up.


CONCLUSIONS
Although the visual prognosis of a combined central retinal artery and vein occlusion is generally poor, our patient experienced an excellent visual recovery more than 1 month after prompt standard of care and a combined intravitreal triamcinolone and bevacizumab injection. Further investigation is necessary to support the efficacy and safety of this approach.
From the *Retina Service, Department of Ophthalmology, The New York Eye and Ear Infirmary; †Einhorn Clinical Research Center, The New York Eye and Ear Infirmary; ‡Vitreous-Retina-Macula Consultants of New York and the Macula Foundation, Inc., of LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; and §New York Medical College, Valhalla, New York.
Verônica Castro
VC
Lima
Tiago S
TS
Prata
Gennady
G
Landa
Lawrence A
LA
Yannuzzi
Richard B
RB
Rosen