Optical Coherence Tomography Angiography Before and After Bevacizumab Injection in Ocular Ischemic Syndrome

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Ocular ischemic syndrome (OIS) is caused by ocular hypoperfusion because of stenosis or occlusion of the carotid arteries.1 Retinal and choroidal ischemia is closely associated with vision loss, which is unfortunately acute and irreversible. Excessive production of vascular endothelial growth factor (VEGF), caused by ischemic condition may lead to the development of secondary glaucoma.
However, no proven treatment to resolve this vicious cycle of ischemia is available. Vascular endothelial growth factor inhibitors have been used to treat macular edema2 or neovascular glaucoma3 complicated by OIS, but the safety and efficacy of the treatment have not been fully verified. This photo essay shows dramatic macular reperfusion in an eye with OIS after an anti-VEGF injection.
A 59-year-old man, who had a history of OIS and neovascular glaucoma, presented with 20/50 best-corrected vision complaining of progressive disturbance of vision in his left eye. He had been diagnosed with stenosis of the left subclavian and internal carotid arteries. Slit-lamp examination showed iris neovascularization. Fundus examination was suspicious for disk neovascularization, whereas no definite maculopathy was noted (Figure 1A). Optical coherence tomography angiography revealed a significant reduction of superficial retinal vascular perfusion (Figure 2A). Intracameral and intravitreal bevacizumab injections were performed. A marked improvement in perfusion of the superficial capillary plexus (Figure 2B) and a complete regression of iris and disk neovascularization were observed at 1 week after injection (Figure 1B).
After a month following the injection, his vision was still at 20/50, but his symptoms improved. Macular perfusion was well maintained (Figure 2C), and a complete regression of neovascularization was achieved. He did not receive any systemic intervention during the follow-up period.
Bevacizumab injection may have exerted a beneficial effect on macular reperfusion, but this case alone cannot prove the precise cause and effect relationship. The correlation shown in these novel findings in optical coherence tomography angiography with an anti–VEGF injection should be evaluated in further studies with control groups.

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