J Korean Ophthalmol Soc.  2022 May;63(5):472-477. 10.3341/jkos.2022.63.5.472.

A Case of Iris Neovascularization in Severe Fungal Keratitis Treated with Intracameral Bevacizumab

• Lim YJ
• Cho CH

• KMID: 2530262
• DOI: http://doi.org/10.3341/jkos.2022.63.5.472

Abstract

Purpose
We report a case in which iris neovascularization (NVI) improved after intracameral bevacizumab injection in a patient who exhibited fungal keratitis with NVI.
Case summary
A 47-year-old man experienced a tree branch-induced injury to his right eye and was treated for keratitis for 1 month. However, his condition deteriorated and he was referred to our hospital. Initial slit lamp biomicroscopy findings showed a large, thick central deep stromal infiltration with a concentric circle shaped feathery-like margin, epithelial defect, satellite lesion, fungal ball, hypopyon, and NVI. Aspergíllus fumigatus was isolated in the corneal scraping culture. Amphotericin B, voriconazole, and natamycin were administered as topical treatment along with systemic amphotericin B. After treatment, the corneal lesions gradually improved, but NVI worsened. After the 5th week, total hyphema occurred; anterior chamber irrigation and intracameral bevacizumab injection were performed. Two weeks postoperatively, the NVI exhibited complete regression; corneal stromal melting with descemetocele appeared after 8 weeks. Penetrating keratoplasty was performed and NVI was no longer observed at 6 months after surgery.
Conclusions
For the treatment of iris neovascularization in patients with infectious keratitis, intracameral bevacizumab injection at an appropriate time may be effective.

Keyword

Anti-vascular endothelial growth factor; Bevacizumab; Fungal keratitis; Intracameral injection; Iris neovascularization