Anterior chamber bevacizumab for rubeotic glaucoma secondary to retinal artery occlusion

Abstract

A 73-year-old Caucasian female, presented with sudden loss of vision in the right eye due to a central retinal artery occlusion (CRAO). The patient presented acutely 10-weeks later with a painful right eye due to rubeosis; intraocular pressure (IOP) was 67 mmHg. A single anterior chamber injection of bevacizumab was performed as an adjunct combination therapy for her neovascularisation. Informed consent to the patient included a detailed explanation of the medication licensing status. 1-week post injection the cornea was clear and there was less rubeosis. Pan-retinal photocoagulation (PRP) was performed and 1 month later there was a marked reduction in rubeosis iridis. At 6 months follow up the patient remains comfortable on prednisolone acetate 1% OD and atropine 1% OD; IOP is 24. As the main trigger for such neovascularisation is retinal ischaemia, the incidence of rubeosis in CRAO is relatively low. Successful combination treatment of rubeosis following CRAO with a single intravitreal injection of anti-VEGF followed by PRP has been reported. In our opinion anterior chamber injection of anti-VEGF may be less invasive than intravitreal delivery. Although there are emerging reports regarding the successful use and efficacy of the anterior chamber route of administration for the treatment of rubeosis from venous occlusion, no such reports have been published following CRAO.