Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin®) for AMD followed by controlateral sympathetic ophthalmia

PURPOSE To report a severe ocular complication initiated ten days after intravitreal administration of bevacizumab (Avastin((R))), in a patient with exudative age-related macular degeneration (AMD). PATIENTS AND METHOD Case report. RESULTS Ten days after intravitreal injection of 1.25 mg Avastin((R)), the patient manifested acute loss of vision with excruciating pain. An extensive choroidal detachment was evident in close contact with the lens, which necessitated an emergency sclerotomy with reconstruction of the anterior chamber. Four months later, the eye proceeded to phthisis bulbi. Five months after the injection, the patient complained of mild pain, photophobia, and visual acuity deterioration from the fellow eye. The diagnosis of sympathetic ophthalmia was suggested and treated with intravitreal injections of triamcinolone acetonide every three months with good response, complicated by elevation of intraocular pressure which we managed with Ahmet valve implantation. CONCLUSION Serious ocular complications after intravitreal of Avastin((R)) can not be excluded, including massive choroidal hemorrhage and sympathetic ophthalmia of the fellow eye.