Intraocular injection of bevacizumab for rubeosis capsulare in a pseudophakic eye

Abstract

Sir, Intraocular injection of bevacizumab for rubeosis capsulare in a pseudophakic eye 'Rubeosis capsulare' is an uncommon condition of neovascularisation within the lens capsule and is not amenable to conventional treatment modalities. 1 Bevacizumab, a humanised monoclonal anti-VEGF antibody is a new modality in the treatment of ocular neovascularisation. We report a rare case of rubeosis capsulare treated successfully with a single dose of intracameral and intravitreal bevacizumab injection. Case reportA 68-year-old man with diabetes and hypertension presented with defective vision of 3 months duration in his left eye (LE) after successful cataract surgery 3 years earlier.His best-corrected visual acuity (BCVA) was perception of light right eye (RE) 6/24 LE. On examination, RE showed a mature cataract and LE had a posterior chamber intraocular lens with extensive neovascularisation and mild fibrous opacification of the posterior capsule, precluding adequate fundus view ( Figure 1a). There was no angle or iris neovascularisation. Intraocular pressures were normal in both eyes (BE). B-scan ultrasonography showed structurally normal posterior segments in BE.He was administered 0.05 ml intravitreal and 0.025 ml intracameral bevacizumab in LE after obtaining informed written consent for off-label use of the same. One week later, the posterior capsule neovascularisation had regressed completely (Figure 1b) with improved media clarity and BCVA had improved to 6/9. Fundus examination showed proliferative diabetic retinopathy in LE for which laser pan-retinal photocoagulation (PRP) was done. The LE remained stable with no recurrence of neovascularisation at 3, 6 months and 1-year follow-up. CommentsBevacizumab has been successful in the treatment of rubeosis iridis and neovascular glaucoma by both intravitreal 2,3 and intracameral routes. 4 It is also efficacious in the treatment of anterior chamber neovascular membrane. 5 MEDLINE search showed a single report on the use of single-dose intravitreal bevacizumab in the treatment of rubeosis capsulare with concomitant iris neovascularisation. 6 In our patient Nd:YAG laser capsulotomy at presentation would have caused bleeding and precluded laser PRP. A single injection of intracameral and intravitreal bevacizumab resulted in the dramatic resolution of the posterior capsule neovascularisation within a week. The improvement in media clarity made laser PRP possible even without Nd:YAG capsulotomy.In summary, bevacizumab offers a new effective option in the treatment of the rare condition of rubeosis capsulare. References 1 Eifrig DE, Hermsen V, McManus P, Cunningham R. Rubeosis capsulare. J Cataract Refract Surg 1990; 16: 633-636. 2 Mason III JO, Albert Jr MA, Mays A, Vail R. Regression of neovascular iris vessels by intravitreal injection of bevacizumab. Retina 2006; 26(7): 839-841. 3 Kahook MY, Schuman JS, Noecker RJ. Intravitreal bevacizumab in a patient with neovascular glaucoma. Intracameral Avastin dramatically resolves iris neovascularization and reverses neovascular g...

Changing paradigms of anti-VEGF in the Indian scenario

“…[123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869] The years between 2007-10, being populated largely by case reports and occasional case series detailing the use of anti-VEGF agents in treating CNVM of other etiology, and retinopathy of prematurity[41] (2007), AMD[3] and adjunct to trabeculectomy[44] (2008). We can see a trend towards randomized case-control studies comparing different anti-VEGF agents, the use of combination treatments in AMD and other diseases since 2011 onwards.…”

“…Indian authors have documented anti-VEGF use in the following conditions:[4445464748495051525354555657]…”