Be wary of anti-VEGF in eyes with bleb

Abstract

We report a case of a 74 years old patient with both eye angle-closure glaucoma, and central retinal vein occlusion with macular edema in the right eye. She underwent intravitreal anti-vascular endothelial growth factors (anti-VEGF) (aflibercept) followed by trabeculectomy with adjunctive mitomycin C (MMC) and a second dose of aflibercept, after which she developed a bleb leak and superior conjunctivial melting. She underwent surgical excision of necrosed conjunctiva followed by conjunctiva autograft. Intravitreal anti-VEGF could potentiate the effect of antimetabolites like MMC. One needs to factor this when managing patients post trabeculectomy who need intravitreal anti-VEGF for management of retinal pathology.