Meta-herpetic ulcer following intravitreal bevacizumab

To report a case of meta-herpetic ulcer that developed after intravitreal bevacizumab injection.

A 55-year-old man with type 2 diabetes mellitus and nephropathy received intravitreal injection of bevacizumab in his right eye for proliferative diabetic retinopathy with macular edema.

Two days after the injection, the patient presented with severe pain, redness, and photophobia, and decreased visual acuity in the right eye. The cornea showed a paracentral epithelial erosion with heaped margins with subepithelial haze and punctate keratopathy, and high intraocular pressure. He initially responded to topical antiviral and antiglaucoma medications. However, it rapidly progressed to a geographic ulcer on initiation of mild steroid and became resistant to conventional medical management. His nephropathy precluded treatment with full dose of systemic antivirals and antiglaucoma drugs. Subsequently, it healed after a paramedian tarsorrhaphy was performed.

Herpetic epithelial keratitis following intravitreal bevacizumab is a rare occurence. However, this case is the first report of progression to a meta-herpetic ulcer.