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   Table of Contents      
LETTER TO THE EDITOR
Year : 2016  |  Volume : 64  |  Issue : 11  |  Page : 861-863

Decompression retinopathy after intravitreal bevacizumab and anterior chamber paracentesis in a patient with neovascular glaucoma


1 Department of Ophthalmology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
2 Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Korea

Date of Web Publication13-Dec-2016

Correspondence Address:
Moosang Kim
Department of Ophthalmology, School of Medicine, Kangwon National University, Kangwondaehakgil 1, Chuncheon, Kangwon 200-701
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.195620

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How to cite this article:
Kim ES, Yu SY, Han SB, Kim M. Decompression retinopathy after intravitreal bevacizumab and anterior chamber paracentesis in a patient with neovascular glaucoma. Indian J Ophthalmol 2016;64:861-3

How to cite this URL:
Kim ES, Yu SY, Han SB, Kim M. Decompression retinopathy after intravitreal bevacizumab and anterior chamber paracentesis in a patient with neovascular glaucoma. Indian J Ophthalmol [serial online] 2016 [cited 2017 Jun 24];64:861-3. Available from: http://www.ijo.in/text.asp?2016/64/11/861/195620

Sir,

Decompression retinopathy is defined as retinal hemorrhages that typically occur after glaucoma filtration surgery.[1] We recently experienced an unusual case of decompression retinopathy following intravitreal bevacizumab injection and anterior chamber paracentesis in a patient with neovascular glaucoma (NVG), thus herein report the case.

A 56-year-old female with type II diabetes, who had been previously diagnosed with bilateral proliferative diabetic retinopathy accompanied with NVG, presented with visual disturbance in his left eye. The best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/400 in the left eye. The intraocular pressure (IOP) was 11 mmHg in the right eye and 47 mmHg in the left eye despite treatment with both topical dorzolamide/timolol fixed combination and brimonidine twice a day. The left pupil was fixed (4 mm) and non-reactive to light. Slit-lamp examination showed active iris neovascularization and mild nuclear sclerosis in the left eye [Figure 1]. Fundus examination of the left eye showed a hazy view due to corneal edema [Figure 2]. We immediately injected intravitreal bevacizumab (1.25 mg/0.05 ml) and performed an anterior chamber paracentesis with a 30-gauge needle in her left eye. No deformation of the globe occurred during the procedure, and the IOP immediately dropped to 10 mmHg in the left eye. One day later, IOP was 22 mmHg and the corneal edema was much resolved. Multiple retinal hemorrhages scattered throughout the posterior pole were revealed in his left fundus examination [Figure 3]. After a 1-month follow-up period, IOP was increased to 35 mmHg. We performed an Ahmed valve implantation combined with cataract surgery in the left eye. Over the next 2 months, the BCVA improved to 20/50 and IOP was controlled at 14 mmHg without any IOP-lowering medication. The multiple retinal hemorrhages gradually faded without sequelae.
Figure 1: Slit-lamp examination of the left eye revealed iris neovascularization and mild nuclear sclerosis

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Figure 2: Fundus examination of the left eye showed a hazy view due to corneal edema

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Figure 3: One day after intravitreal bevacizumab and anterior paracentesis, fundus photograph of the left eye showed multiple retinal hemorrhages scattered throughout the posterior pole

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Intravitreal bevacizumab is now frequently used as an adjunct treatment for NVG. In advanced NVG, however, bevacizumab cannot control IOP but may be used adjunctively to improve subsequent surgical outcomes.[2] Paracentesis is a very useful method that promptly decreases pressure in patients with high IOP, even on medical treatment. Normal retinal blood vessels are capable of efficient autoregulation.[3] Whereas, autoregulatory dysfunction has been reported in patients with glaucoma and it may contribute to the development of retinal hemorrhage.[4] The sudden reduction of IOP following intravitreal bevacizumab and anterior paracentesis may have caused a correspondingly large increase of perfusion pressure of the retinal arteries. This in turn may have overwhelmed the autoregulatory capacity of the retinal vasculature, resulting in multiple hemorrhages.

In conclusion, this case demonstrates that decompression retinopathy can occur following intravitreal bevacizumab and anterior paracentesis. Precautions should be taken to reduce the risk of this complication. A sudden drop of the IOP should be avoided by a careful anterior paracentesis, releasing the aqueous very slowly, to prevent shallow anterior chamber during the paracentesis. It may also be beneficial to perform paracentesis in several smaller stages to reduce the risk of adverse responses to a sudden decrease in IOP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Fechtner RD, Minckler D, Weinreb RN, Frangei G, Jampol LM. Complications of glaucoma surgery. Ocular decompression retinopathy. Arch Ophthalmol 1992;110:965-8.  Back to cited text no. 1
    
2.
Wakabayashi T, Oshima Y, Sakaguchi H, Ikuno Y, Miki A, Gomi F, et al. Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal diseases in 41 consecutive cases. Ophthalmology 2008;115:1571-80.  Back to cited text no. 2
    
3.
Geijer C, Bill A. Effects of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys. Invest Ophthalmol Vis Sci 1979;18:1030-42.  Back to cited text no. 3
    
4.
Nah G, Aung T, Yip CC. Ocular decompression retinopathy after resolution of acute primary angle closure glaucoma. Clin Exp Ophthalmol 2000;28:319-20.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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