International Medical Case Reports Journal (Oct 2019)
Combined Intravitreal Bevacizumab And Dexamethasone In Bilateral Lupus Retinopathy
Abstract
Ruchi Shrestha,1 Ranju Kharel Sitaula,1 Pratap Karki,1 Sagun Narayan Joshi,1 Suniti Rawal2 1Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal; 2Department of Gynaecology and Obstreitics, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NepalCorrespondence: Ruchi ShresthaDepartment of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj Road, Kathmandu 44600, NepalTel +977-9847027650Email [email protected]: This paper reports and discusses a case of bilateral lupus retinopathy with macular edema in a patient diagnosed with systemic lupus retinopathy and treated with combined intravitreal bevacizumab (0.025 mL/0.625 mg) and intravitreal dexamethasone (0.05 mL/0.2 mg). The patient was a 25-year-old female with a history of diminution of vision in both eyes. Best corrected visual acuity (BCVA) of the right eye was 2/60 and of the left eye was 1/60. Fundus examination revealed bilateral swelling of the optic disc nasally, cotton wool spots, and multiple flame shaped, dot and blot hemorrhages in the disc and macula. Optical coherence tomography (OCT) revealed macular edema in both eyes. Despite being treated with immunosuppressive the visual acuity did not improve. Two doses of combined intravitreal bevacizumab (0.025 mL/0.625 mg) and dexamethasone (0.05 mL/0.2 mg) were given to the patient in both eyes at an interval of one week. Two weeks after the last intravitreal injection the BCVA was 6/24 and N8 in both eyes. Fundus examination revealed a decrease in the number and size of hemorrhages, and resolution of the blurred disc margin, cotton wool spots, and hard exudates. OCT of the macula 2 weeks after the last intravitreal injection showed a significant decrease in macular edema. The intraocular pressure was not elevated for a period of 6 months. This case would be a unique case of lupus retinopathy with macular edema receiving a combined half dose of intravitreal injection bevacizumab and dexamethasone with promising results. This could be beneficial in a set up where the patients cannot afford intraocular steroid implants.Keywords: systemic lupus erythematosus, macular edema, bevacizumab, dexamethasone
