Effect of intravitreal bevacizumab on intraocular pressure in a case of severe chronic hypotony.

Purpose: Chronic severe hypotony is associated with many serious ocular consequences, including phthisis. This case illustrates a possible new therapy for chronic hypotony.

Methods: This study is a case report of a 75-year-old man who had undergone trabeculectomy followed by multiple retinal surgeries and developed chronic hypotony in the left eye for more than 1 year.

Results: Treatment with intravitreal bevacizumab led to an elevation of intraocular pressure to 8 mmHg 1 week later. Hypotony returned within 2 weeks (2 mmHg) and variably remained for 2 months (0-10 mmHg) until a repeat injection of intravitreal bevacizumab resulted in another elevation in intraocular pressure, which was sustained (5-8 mmHg over 2 months). We postulate that antivascular endothelial growth factor therapy may influence aqueous production through restoration of tight junctions in the nonpigmented ciliary epithelium. Vascular endothelial growth factor and antivascular endothelial growth factor therapies have been demonstrated to modulate tight junctions in many other tissues in the body, including retinal pigment epithelium, ovarian tissue, vascular endothelium, liver, and brain vasculature.

Conclusion: We postulate that antivascular endothelial growth factor therapy may play a role in treating hypotony by enhancing the function of tight junctions in the ciliary body and restoring aqueous production. Further studies are necessary to better clarify the influence of antivascular endothelial growth factor on intraocular pressure and aqueous production.