Combined Intracorneal and Subconjunctival Bevacizumab Injections for Recurrent Visual Loss and Intraocular Hemorrhage from Vascularized Fibrous Downgrowth

BACKGROUND: Epithelial and fibrous downgrowths result from persistently leaky wounds with conjunctival or corneal epithelium and fibroblasts growing over corneal endothelium, iris and angle structures, leading to corneal edema and difficult-to-control glaucoma. Therapies have included en bloc resection, cryotherapy, endolaser or external photocoagulation and either 5-fluorouracil or mitomycin C injections. A new complication and a novel therapy are presented. CASE PRESENTATION: A 44-year-old uniocular housewife sustained a large corneoscleral laceration following a fall. She underwent primary suturing and was subsequently referred for repair of retinal detachment. She underwent resuturing of her gaping wound, pars plana vitrectomy and scleral buckle. Postoperative visual acuity was 6/120 due to a large macular hole. Visual acuity dropped to hand motion 5 times in a recurrent fashion due to diffuse intraocular hemorrhage. Vascularized fibrous downgrowth was the identifiable source of bleeding into the anterior and posterior chambers. This was controlled by 21 intracorneal and subconjunctival bevacizumab injections over 2.5 years of therapy. CONCLUSION: Repeated bevacizumab injections can control intraocular bleeding from new vessels accompanying fibrous downgrowth with preservation of vision.