Acute vision loss associated with retinal circulatory disturbances after intravitreal injection of bevacizumab

Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), specifically binds to VEGF protein, and inhibits angiogenesis. Intravitreal/intracameral injection of bevacizumab has been reported as another treatment option for patients with various ocular ischemic conditions. However, we report 4 cases of acute vision loss after bevacizumab intravitreal injection.

Intravitreal bevacizumab injections were administrated to 2 ocular ischemic syndrome (OIS) patients and 2 central retinal vein occlusion (CRVO) patients. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), funduscopic findings, and fluorescein angiography were evaluated before and after the treatments.

All 4 cases presented with acute vision loss within 1 week after bevacizumab injection, before its clearance from the eye, and showed that microcirculatory disturbances occurred in the retina.

We believe that intravitreal injection of bevacizumab should be undertaken with extreme caution in patients with a history of cerebral infarction, especially with OIS or nonischemic CRVO, and with diabetic retinopathy and vitrectomized eye with pseudophakia.