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Ng CC, Brill D, Cunningham ET, et al. Catastrophic, Bilateral Retinal Vascular Occlusion after Intravitreal Bevacizumab Injection. Retin Cases Brief Rep. 2021;doi: 10.1097/ICB.0000000000001158.
Ng, C. C., Brill, D., Cunningham, E. T., Burckhard, B. A., Jumper, J. M., Heier, J., Rifkin, L. M., Eliott, D., McDonald, H. R., & Sobrin, L. (2021). Catastrophic, Bilateral Retinal Vascular Occlusion after Intravitreal Bevacizumab Injection. Retinal cases & brief reports, . https://doi.org/10.1097/ICB.0000000000001158
Ng, Caleb C, et al. "Catastrophic, Bilateral Retinal Vascular Occlusion after Intravitreal Bevacizumab Injection." Retinal cases & brief reports vol. (2021). doi: https://doi.org/10.1097/ICB.0000000000001158
Ng CC, Brill D, Cunningham ET, Burckhard BA, Jumper JM, Heier J, Rifkin LM, Eliott D, McDonald HR, Sobrin L. Catastrophic, Bilateral Retinal Vascular Occlusion after Intravitreal Bevacizumab Injection. Retin Cases Brief Rep. 2021 May 10; doi: 10.1097/ICB.0000000000001158. Epub 2021 May 10. PMID: 33988542.
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Retin Cases Brief Rep. 2021 May 10; doi: 10.1097/ICB.0000000000001158. Epub 2021 May 10.

Catastrophic, Bilateral Retinal Vascular Occlusion after Intravitreal Bevacizumab Injection.

Retinal cases & brief reports

Caleb C Ng, Daniel Brill, Emmett T Cunningham, Braden A Burckhard, J Michael Jumper, Jeffrey Heier, Lana M Rifkin, Dean Eliott, H Richard McDonald, Lucia Sobrin

Affiliations

  1. West Coast Retina Medical Group, San Francisco, California. The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Immunology and Uveitis Service, Boston, Massachusetts. The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California. The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Vitreoretinal Service, Boston, Massachusetts. Ophthalmic Consultants of Boston, Vitreoretinal Service, Boston, Massachusetts. Ophthalmic Consultants of Boston, Uveitis Service, Boston, Massachusetts.

PMID: 33988542 DOI: 10.1097/ICB.0000000000001158

Abstract

PURPOSE: To describe two cases of catastrophic, bilateral retinal vascular occlusion following intravitreal (IVT) bevacizumab injection.

METHODS: Case series. Main outcome measures included clinical and fluorescein angiography (FA) findings.

RESULTS: Case 1 - A 65-year-old woman with calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis (CREST) syndrome developed acute, severe, bilateral visual loss two weeks following bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and FA revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2 - An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left then right eye approximately three weeks following IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. FA showed diffuse venous leakage. Extensive testing revealed an elevated anti-nuclear antibody and mildly elevated anti-cardiolipin antibody.

CONCLUSION: Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion following treatment with IVT bevacizumab. The moderate to severe intraocular inflammation in both cases, and the contralateral involvement following unilateral IVT injection in Case 2, suggest a possible delayed immune-mediated mechanism.

Copyright © 2021 by Ophthalmic Communications Society, Inc.

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