Herpes simplex virus keratouveitis recurrence following intravitreal bevacizumab injection

We report a case of recurrence of herpes simplex virus (HSV) keratouveitis following the intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO) in a previously adequately treated patient of herpetic keratouveitis. A 47-year-old man with the previous history of HSV keratouveitis was administered 2 doses of intravitreal bevacizumab in the right eye for CRVO, at an interval of 4 weeks. Following the second dose, the patient developed decreased vision, corneal edema, and anterior segment inflammation. Since he was a previously known case of HSV keratouveitis with a positive polymerase chain reaction for HSV from the aqueous, oral valacyclovir was started along with topical steroids and cycloplegics. He showed a good response to treatment with resolution of keratouveitis. This case demonstrates that the recurrence of herpetic keratouveitis can be a possible complication of intravitreal bevacizumab, which may occur even after prior uneventful injections.