Elena Pacella¹, Paolo Turchetti², Marco Artico¹, Carmen Domenica Piraino¹, Antonella Mollicone¹, Andrea Bottone¹, Francesca Romana Parisiella³, Fernanda Pacella^1,

Introduction: Antiangiogenic agents are often administered for treatment of Branch Retinal Vein Occlusion (BRVO). Among them, Bevacizumab has noticeable antiangiogenic and antiedemigenic properties and possesses great capacity to penetrate the retinal tissue, particularly in pathological circumstances characterized by altered external or internal blood-retinal barrier.Bevacizumab has an optimal bio-efficacy based on inhibition of the activity of Vascular Endothelial Growth Factor (VEGF). Nonetheless, despite its efficacy, here we describe the adverse effects associated with intraocular injection of bevacizumab in a patient affected by retinal vein occlusion. Case presentation: We present a case report of an 11-year old Caucasian malesubject affected by BRVO in his left eye. The patient underwent an intra-vitreal (i.v.) injection of bevacizumab 100 (1.25 mg/0.05ml). After that, the patient was monitored over time through a series of analyses including Ocular Coherence Tomography, Fluorangiography, Bulbar Ultrasound, Angio MRI BCVA scores and Intra Ocular Pressure. Results: Immediately after the i.v. injection, the patient experienced a strong and relentless pain radiating from the left ocular orbit, caused by a serious and unexpected malignant glaucoma and phthisis bulbi. Furthermore, the patient did not show any sign of improvement in visual function in the follow-up and at last required an ophthalmic prosthesisas a result of a sub-atrophic and hypotonic eyeball. Conclusion: This case report suggests that i.v. injections of anti-VEGFs should be considered with caution when treating central and branch vein occlusion, and are not free of complications in certain clinical cases.

retinal vein and vascular occlusion, macular edema, intravitreal anti-VEGF, malignant glaucoma