Abstract
BackgroundTo report engorged vessel occlusion after repeated intravitreal injections of bevacizumab to treat the macular oedema in a case of arteriovenous malformation.Case presentationA 37-year-old woman presented with a sudden, painless loss of vision in her left eye. Her visual acuity was 20/200 in the left eye, and 20/20 in the right eye. Ophthalmoscopic examination revealed an abnormal tangle of vessels and enlarged draining veins. A fluorescence angiogram revealed fluorescence leakage at a turn near the fovea. Horizontally oriented optical coherence tomography revealed an increased macular thickness and an accumulation of intraretinal fluid, indicating macular oedema. After three intravitreal injections of 1.25 mg bevacizumab, her vision improved to 20/20. Ophthalmoscopic examination revealed a decreased calibre of the previously engorged draining veins and ghost vessels. Repeated horizontally oriented optical coherence tomography revealed a decreased macular thickness and the absence of an intraretinal cyst. At the 2-year follow-up visit, the vision of the patient was stable.ConclusionThis finding implies that certain middle-size vessels can become occluded during anti- vascular endothelium growth factor (anti-VEGF) therapy, which could induce fatal complications if it occurred in the heart or brain. Clinicians should be cautious of the potential thrombotic effects on systemic blood vessels when administering anti-VEGF treatment.
Highlights
To report engorged vessel occlusion after repeated intravitreal injections of bevacizumab to treat the macular oedema in a case of arteriovenous malformation.Case presentation: A 37-year-old woman presented with a sudden, painless loss of vision in her left eye
This finding implies that certain middle-size vessels can become occluded during anti- vascular endothelium growth factor therapy, which could induce fatal complications if it occurred in the heart or brain
Clinicians should be cautious of the potential thrombotic effects on systemic blood vessels when administering anti-VEGF treatment
Summary
We chose to use anti-VEGF because we observed fluorescence leakage and retinal oedema during optical coherence tomography. The vision of the patient improved to 20/20 and remained stable for 2 years after the three intravitreal injections of bevacizumab, the regression of the abnormal, engorged mature vessels after treatment was unexpected. This thromboembolic event can be explained by either spontaneous involution or induced platelet aggregation followed by degranulation and thrombosis through the formation of a complex with VEGF and activation of the platelet FcγRIIa receptor [6].
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