Visual hallucinations after intravitreal injection of bevacizumab in vascular age-related macular degeneration

To describe transient structured visual hallucinations in a patient with vascular age-related macular degeneration (AMD), following an intravitreal Avastin-injection.

Interventional case reports.

A fully alert 83-year-old woman with disciform scar right eye (OD) and occult choroidal neovascularization (CNV) left eye (OS) experienced a progressive visual loss to 20/800 OD and 20/400 OS. A coherent 84-year-old woman with occult CNV both eyes (OU) experienced decreased vision of 20/800 OU. After both patients gave informed consent, an uneventful intravitreal injection of 1.25 mg Avastin was performed in the left eyes.

One day and three days after an uneventful intravitreal injection both patients experienced structured hallucinations including trees, faces, and water for approximately 15 to 30 minutes.

We report a typical symptoms of Charles-Bonnet syndrome (CBS) in patients with severe AMD after intravitreal Avastin-injections. The reduced retinal edema and realignment of the photoreceptors may promote the release phenomenon and trigger hallucinatory episodes.