Tractional Retinal Detachment After Intravitreal Bevacizumab (Avastin®) Injection in Proliferative Diabetic Retinopathy

Abstract

Purpose: To report two cases of tractional retinal detachment after intravitreal bevacizumab injection. Case summary: (Case 1) A 48-year-old female with insulin-dependent diabetes mellitus and a high HbA1c level came to our clinic for fundus evaluation. The best corrected visual acuity (BCVA) was 1.0 in the right eye and funduscopic examination of the right eye revealed proliferative diabetic retinopathy with preretinal hemorrhage and a mild fibrovascular proliferative membrane around the optic disc. Intravitreal bevacizumab injection (1.25 mg) was performed before starting panretinal photocoagulation (PRP) to prevent macular edema after PRP. Three days after the injection, visual acuity decreased to 0.3 and funduscopic findings showed tractional retinal detachment. Vitrectomy was performed and visual acuity recovered to 1.0 four months after operation. (Case 2) A 42-year-old male with insulin-dependent diabetes mellitus and a high HbA1c level came to our clinic for fundus evaluation. BCVA was 0.5 in the right eye and funduscopic examination of the right eye revealed proliferative diabetic retinopathy with vitreous hemorrhage and a mild fibrovascular proliferative membrane around the optic disc. Intravitreal bevacizumab injection (1.25 mg) was performed before starting panretinal photocoagulation (PRP) to prevent macular edema after PRP. One month after the injection, visual acuity decreased to 0.1 and funduscopic findings showed tractional retinal detachment. Vitrectomy, intravitreal silicone oil injection, and sequential silicone oil removal were performed and visual acuity recovered to 0.6 at the final examination. Conclusions: Intravitreal bevacizumab injection may cause tractional retinal detachment in poorly controlled insulin-dependent diabetes mellitus patients with fibrovascular proliferative membranes.