Optic Disc Edema Responding to Localized Anti-vascular Endothelial Growth Factor Treatment in a Patient with POEMS Syndrome

Dear Editor, Although various underlying conditions such as increased intracranial pressure, inflammation, ischemia, or compression can induce optic disc edema (ODE), all forms of disc swelling ultimately result from blockage of axo-plasmic transport [1]. In contrast to these types of ODE, which can generally be managed by systemic treatment of the underlying etiology, we describe a case of ODE treated with intravitreal bevacizumab injection in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclo-nal gammopathy, and skin changes (POEMS) syndrome, a rare multisystemic disorder associated with a high serum vascular endothelial growth factor (VEGF) level [2]. A 58-year-old man with POEMS syndrome was referred to the ophthalmology department with an 1-month history of bilateral blurred vision and an 1-week history of a round blind spot in the left eye. He also had an 8-year history of POEMS syndrome, which had been in remission for the past 7 years, following treatment with chemotherapy combined with steroids for the first 1 year. He was admitted because of generalized edema and pulmonary hypertension, which began 1 week before. He underwent 3-week systemic treatment with high-dose dexamethasone, which was started one day before the first ophthalmologic examination. He did not have any other past medical problems. Best-corrected visual acuity was 20 / 30 in the right eye and 20 / 50 in the left eye. Fundus examination and optical coherence to-mography revealed bilateral ODE and subretinal fluid in the left eye, and fluorescein angiography (FA) demonstrated prominent leakage from the optic disc in both eyes (Fig. 1A-1F). Neither intraretinal microvascular abnormalities nor retinal neovascularization were observed (Fig. 1A and 1F). After obtaining informed consent, three monthly injections of intravitreal bevacizumab (1.25 mg) were administered to the left eye. Two months after the final injection, both eyes were evaluated with color photos, optical coherence tomography and FA (Fig. 1G-1L). ODE and subretinal fluid showed gradual response and best-corrected visual acuity was improved to 20 / 20 in the left eye (Fig. 1J and 1K). FA also demonstrated decreased disc leakage in the left eye (Fig. 1L). In contrast, right ODE remained unchanged on both optical coherence tomography and FA (Fig. 1G-1I). Eight months after the final injection, ODE and disc leakage were decreased in both eyes and general condition was improved (Fig. 1M-1R). No definite ODE or leakage was observed in the left eye (Fig. 1P-1R). POEMS syndrome is associated with manifestations of increased vascular permeability such …