Sir,

Bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has been given as an intravitreal injection for choroidal neovascularization (CNV) secondary to age-related macular degeneration,1 myopia,2 and angioid streaks3 with promising functional results. Here, we present a case of subfoveal CNV secondary to traumatic choroidal rupture, which regressed with intravitreal bevacizumab. We are unaware of such a report in world literature.

Case report

A 25-year-old woman presented with diminution of vision in her right eye for 1-month duration. The patient had sustained a blunt injury in the right eye with a ball 4 months back.

The best-corrected visual acuity (BCVA) was 20/200 OD and 20/20 OS. Anterior segment examination was normal bilaterally. The intraocular pressures were 10 mmHg bilaterally. Ophthalmoscopic examination of the right eye revealed a curvilinear choroidal rupture just temporal to the fovea with a small, orange-coloured subfoveal lesion and associated subretinal haemorrhage (Figure 1). Left eye fundus was normal.

Figure 1
figure 1

Fundus photographs (left-hand column), fluorescein angiography (FA) results, and optical coherence tomography (OCT) results (right-hand column) along the horizontal meridian from temporal to nasal, revealing the presence of a subfoveal choroidal neovascular membrane. Preinjection (top) and 4 weeks postinjection photographs (bottom) are shown. FA shows staining of the membrane, and OCT shows shrinkage of the neovascular membrane with resolution of intraretinal oedema following intravitreal bevacizumab therapy. Retinal thickness measured by OCT at baseline (330 μ; top right) and after 4 weeks (221 μ; bottom right).

Full size image

Fluorescein angiography (FA) showed transmission hyperfluorescence corresponding to the choroidal rupture and an associated subfoveal hyperfluorescent lesion with late leakage of dye in the right eye. Optical coherence tomography (OCT) revealed the presence of a subfoveal CNV with intraretinal oedema in the right eye (Figure 1). The central macular thickness (CMT) on OCT was 330 μ OD and 201 μ OS.

After a written consent was signed by the patient, an off-label intravitreal bevacizumab injection (1.25 mg) was given in the right eye. At 4 weeks, BCVA improved to 20/50 OD and FA showed staining of the neovascular membrane. The CMT on OCT decreased to 221 μ OD with a reduction in lesion size (Figure 1). After 6 months, the vision was maintained at 20/50 OD with a scarred subfoveal membrane.

Comment

Choroidal ruptures are breaks in the choroid, Bruch's membrane, and the retinal pigment epithelium that occur from blunt ocular trauma. In 15–30% of patients, CNV may occur and lead to haemorrhagic or serous macular detachment with concurrent central vision loss. The formation of CNV is strongly associated with proximity of the rupture to the fovea and the length of the rupture.4 Photodynamic therapy has been reported for the management of such membranes;5 however, certain limitations like high expenses involved and post-treatment risk of vision loss are present.

In this case, bevacizumab not only hastened the regression of the neovascular membrane but also provided superior visual outcome. Intravitreal bevacizumab is also well tolerated and no adverse effects were observed. The results observed in this case are provocative and require further investigation.