Anterior segment ischemia with rubeosis iridis after a circular buckling operation treated successfully with an intravitreal bevacizumab injection: a case report and review of the literature.

Abstract

Purpose: To report a case of anterior segment ischemia (ASI) with rubeosis iridis after circular buckling surgery in a highly-myopic patient which was successfully treated with a second intravitreal bevacizumab injection.

Methods: Case report and review of the literature.

Discussion: ASI is a rare but potentially serious complication of posterior segment surgery. Finally it leads to neovascular glaucoma as a result of rubeosis iridis. An encircling band can compromise anterior segment circulation in different ways: by manipulation or disinsertion of the recti muscles, by occlusion of the vortex veins through compression or by changes in the blood supply of iris and ciliary body. This patient developed rubeosis iridis secondary to ASI. There was a remarkable regression of rubeosis iridis one month after a second intravitreal bevacizumab injection. Other case reports of bevacizumab use in neovascular glaucoma have shown clinical improvements of these patients, with intraocular pressure control and reduction of the neovascularization process.

Conclusion: We describe a highly-myopic patient who developed ASI with rubeosis iridis after a circular buckling operation. Slit-lamp examination and gonioscopy can show very little rubeosis iridis and can be misleading. Iris fluorescein angiography is the most sensitive technique for evaluation of iris vessel abnormalities and is of considerable value in the early detection of rubeosis iridis. This report demonstrates the rapid resolution of rubeosis iridis on iris fluorescein angiography after a second intravitreal injection of bevacizumab. How long this regression will persist is unknown and repeated injections of bevacizumab may be necessary if rubeosis reappears.