Intravitreal bevacizumab for posterior capsule neovascularization

Abstract

We report a case of rapid regression of extensive posterior capsule neovascularization in a 67-year-old diabetic male patient, who developed posterior capsule opacity with neovascularization one year post cataract surgery, after a single injection of intravitreal bevacizumab (Avastin) followed by neodymium:YAG capsulotomy. Rapid regression of the posterior capsule neovascularization, and visual improvement was observed 9 days after the intervention. Posterior capsulotomy was performed successfully without bleeding. Prior to posterior capsulotomy, intravitreal bevacizumab can result in rapid and dramatic regression of posterior capsule neovascularization.

Posterior lens capsule neovascularization treated with anti-VEGF complicated by phacogenic uveitis

“…The earliest case of NVPC was reported by Erig et al, in 1990, who coined the term “rubeosis capsulare” in two diabetic patients following cataract extraction. 6 While most NVPC cases since have reported the same etiology 1 , 2 , 4 , other etiologies include idiopathic ciliary body inflammation 3 , surgical interventions (pneumatic retinopexy and pars plana vitrectomy) 5 , and traumatic microcapsular breach. 7 Cases of NVPC occurring with NVI 2 , 6 and in isolation 3 , 5 have both been reported.…”

“…Previous studies have reported successful management of NVPC with intravitreal bevacizumab (Avastin) injections followed by Nd:YAG capsulotomy. 1 , 2 , 4 Other treatments that have been reported include photodynamic therapy followed by Nd:YAG capsulotomy 5 and vitrectomy. 6 In all these reported cases, treatment restored VA close to baseline, and no recurrence of NVPC noted on their latest follow-up visits, which ranged upwards of nine months.…”

“…The rationale for using an anti -VEGF agent in the treatment of NVPC is to decrease the risk of vitreous hemorrhage during or following a Nd:YAG capsulotomy which has been successfully established with the use of bevacizumab in three cases reports. 1 , 2 , 4 In our case report, we chose to use ranibizumab, a recombinant humanized anti -VEGF-A monoclonal antibody in an off-label fashion, as this drug was used in this patient's prior history for the treatment of CRVO. We report a successful regression of the NVPC as noted at the three-week follow-up, allowing the Nd:YAG capsulotomy to be performed without any hemorrhagic complications.…”

“…Neovascularization of the posterior capsule (NVPC) is a rarely reported occurrence characterized by vascular proliferation behind the posterior lens capsule causing opacification and decreased visual acuity. 1 , 2 , 3 , 4 , 5 , 6 , 7 Neovascularization in various areas of the eye is a common phenomenon caused by the secretion of vascular endothelial growth factor (VEGF) driven by ischemia. Therapeutic inhibition of VEGF is one treatment option which leads to regression of neovascular vessels, reducing the downstream complications such as intraocular hemorrhage, neovascular glaucoma, and tractional retinal detachments.…”