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Progression of tractional retinal detachment following intravitreal bevacizumab

2008; Wiley; Volume: 87; Issue: 5 Linguagem: Inglês

10.1111/j.1755-3768.2008.01225.x

1755-3768

Jost B. Jonas, Matthias Schmidbauer, Florian Rensch,

Retinal and Macular Surgery

Editor, Since the landmark study by Rosenfeld and colleagues on the efficacy of intravitreally administered bevacizumab for the treatment of exudative age-related macular degeneration (ARMD) (Michels et al. 2005; Rosenfeld et al. 2005), bevacizumab has become a globally used intravitreal medication. Soon after its first application for the treatment of exudative ARMD, intravitreal bevacizumab was administered as an adjunct for the treatment of neovascular and oedematous changes in eyes with ischaemic retinopathies such as diabetic retinopathy and ischaemic retinal vein occlusions (Grisanti et al. 2006; Iliev et al. 2006; Mason et al. 2006; Silva Paula et al. 2006;Chilov et al. 2007; Dell'omo et al. 2007; Jonas et al. 2007; Lee & Koh 2007; Minnella et al. 2007;Ruiz-Moreno et al. 2008; Shima et al. 2008; Soliman et al. 2008; Tonello et al. 2008; Yazdani et al. 2007). The observed anti-neovascular effect of intravitreal bevacizumab on iris and retinal neovascularization was unprecedented. As in any new therapy, however, unknown side-effects may occur. It was the purpose of the present study to report on such an unexpected side-effect of intravitreal bevacizumab. A 27-year-old female patient suffering from insulin-dependent diabetes mellitus experienced a loss of vision and discomfort in her left eye. Visual acuity was 0.10 (right eye) and 0.60 (left eye), and intraocular pressure measured 12 mmHg (both eyes). Ophthalmoscopy showed a tractional retinal detachment caused by a retinovitreal neovascular membrane, extending from the optic disc to the temporal superior vascular arcade. After informing the patient about the experimental character of the therapy and receiving informed consent, the patient was given an intravitreal injection of bevacizumab to reduce the intraocular neovascularization, to prevent the development of iris neovascularization and neovascular glaucoma, and to prepare the eye for a planned panretinal laser coagulation. Within 1 week of the injection, the patient noticed a rapidly progressing paracentral scotoma in her left visual field. Ophthalmoscopy revealed an almost complete closure of the blood vessels in the papillovitreal neovascular proliferation with a secondary shrinkage of the membrane leading to a progression of the tractional retinal detachment in the direction of the fovea. In view of the rapidly progressing retinal detachment and the threat of central fixation, a pars plana vitrectomy was performed with the removal of the retinovitreal neovascular membrane, silicone oil endotamponade and panretinal endolaser coagulation. The findings suggest that intravitreal bevacizumab can lead to the progression of a tractional retinal detachment in patients with pre-existing diabetic tractional retinal detachment. The present report agrees with another recent study on 11 out of 211 patients with proliferative diabetic retinopathy who developed or showed a progression of tractional retinal detachment after the intravitreal administration of bevacizumab (Arevalo et al. 2007). The reason for the progression of the retinal detachment may be shrinkage of the neovascular retinovitreal membrane leading to a contraction and further elevation of the retina. In conclusion, intravitreal bevacizumab injections may lead to the progression of a tractional retinal detachment and loss of vision in patients with proliferative ischaemic retinopathies and pre-existing tractional retinal detachments. In view of the increasing use of intravitreal bevacizumab in the treatment of neovascular glaucoma (Grisanti et al. 2006; Iliev et al. 2006; Mason et al. 2006; Silva Paula et al. 2006; Chilov et al. 2007; Dell'omo et al. 2007; Yazdani et al. 2007), the complication of the progression of a tractional retinal detachment may have to be taken into account.