Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection

Moses Kim; Ju Byung Chae

doi:10.3341/jkos.2014.55.5.780

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Kim and Chae: Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection

Case Report

J Korean Ophthalmol Soc 201;55(5):780-784.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.780

Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection

Moses Kim, MD, Ju Byung Chae, MD

Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Ju Byung Chae, MD, Department of Ophthalmology, Chungbuk National University Hospital, #776 1sunhwan-ro, Heungdeok-gu, Cheongju, 361-763, Korea, Tel: 82-43-269-6335, Fax: 82-43-269-5263, E-mail: jbchae@chungbuk.ac.kr

Received 31 May 2013 Revised 22 November 2013 Accepted 1 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying pars plana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage.

Case summary

A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presented with decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV with intravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in the anterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosed with non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance of the vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumab injection cleared the vitreous hemorrhage with no evidence of vitreous web.

Conclusions

Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatment of DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anterior chamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections.

Keywords: Intraocular inflammation, Vitreous hemorrhage

References

1. Spaide RF, Laud K, Fine HF, et al. Intravitreal bevacizumab treat-ment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 2006; 26:383–90.

2. Iturralde D, Spaide RF, Meyerle CB, et al. Intravitreal bev-acizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina. 2006; 26:279–84.

3. Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: re-sults from the pan-American collaborative retina study group at 6-month follow-up. Ophthalmology. 2007; 114:743–50.

4. Moradian S, Ahmadieh H, Malihi M, et al. Intravitreal bev-acizumab in active progressive proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2008; 246:1699–705.

5. Rich RM, Rosenfeld PJ, Puliafito CA, et al. Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina. 2006; 26:495–511.

6. Avery RL, Pieramici DJ, Rabena MD, et al. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006; 113:363–72.

7. Chen CY, Wong TY, Heriot WJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration: a short-term study. Am J Ophthalmol. 2007; 143:510–2.

8. Wickremasinghe SS, Michalova K, Gilhotra J, et al. Acute intra-ocular inflammation after intravitreous injections of bevacizumab for treatment of neovascular age-related macular degeneration. Ophthalmology. 2008; 115:1911–5.

9. Chiang A, Reddy S, Tsui I, Hubschman JP. Vitreous web after pars plana vitrectomy and bevacizumab with fluid-air exchange. Semin Ophthalmol. 2011; 26:25–7.

10. Jonas JB, Spandau UH, Rensch F, et al. Infectious and non-infectious endophthalmitis after intravitreal bevacizumab. J Ocul Pharmacol Ther. 2007; 23:240–2.

11. Martin DF, Maguire MG, Ying GS, et al. Ranibizumab and bev-acizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364:1897–908.

12. Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bev-acizumab for treatment of neovascular age-related macular degener-ation: two-year results. Ophthalmology. 2012; 119:1388–98.

13. Schepens CL. Clinical and research aspects of subtotal open-sky vitrectomy- XXXVII Edward Jackson Memorial Lecture. Am J Ophthalmol. 1981; 91:143–71.

14. Mamalis N, Edelhauser HF, Dawson DG, et al. Toxic anterior seg-ment syndrome. J Cataract Refract Surg. 2006; 32:324–33.

15. Shimura M, Yasuda K, Nakazawa T, et al. Panretinal photo-coagulation induces pro-inflammatory cytokines and macular thickening in high-risk proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2009; 247:1617–24.

Figure 1.

Vitreous hemorrhage is observed in the right eye (A). At postoperative day 1, multiple inflammatory web-like white strands (vitreous web) are seen (B). At postoperative day 4, multiple inflammatory web-like white strands (vitreous web) disappeared (C). At postoperative 1 month, there are no multiple inflammatory web-like white strands (vitreous web) (D). At postoperative day 1 and 1 month, there are no inflammatory web-like white strands (vitreous web) at left eye (E, F).

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