Morteza Entezari, Alireza Ramezani, Hassan Ghassemi, Alireza Naderi Ophthalmic Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.

Purpose:

To report the effect of combined intravitreal bevacizumab and triamcinolone acetonide injection on acute nonarteritic anterior ischemic optic neuropathy (NAION). It has been hypothesized that VEGF increases vascular permeability and may play a role in tissue injury in eyes with NAION. Furthermore, inhibition of VEGF signaling reduces cerebral edema and tissue injury in animal models. On the other hand, triamcinolone decreases inflammatory-related edema and therefore diminishes tissue destruction. Both of these drugs have recently been used with no major complications.

Methods:

Intravitreal injection of 1.25 mg bevacizumab and 2 mg triamcinolone in patients with acute NAION.

Effectiveness / Safety:

Based on the results achieved in three cases, this intervention was an effective treatment method in patients with recent NAION. Visual acuity improved in all three cases at 4 months; from 1/100 at baseline to 1/10, 2/10 to 6/10, and 8/10 to 10/10. Compared to the baseline, visual field also improved in all eyes. No complications were encountered in these three cases. Take home message: combined intravitreal injection of bevacizumab and triamcinolone may have promising effects in the treatment of acute NAION.