Intravitreal bevacizumab (Avastin) associated with secondary hyphaema in a case of proliferative sickle cell retinopathy

Intravitreal bevacizumab (Avastin) has been used off label for various conditions, including proliferative sickle cell retinopathy (PSR). Some authors have reported a more rapid resolution of the vitreous haemorrhage in Goldberg stage 4 PSR. Following injection of 1.25 mg of bevacizumab in each eye in a case of PSR (right eye with stage 3 sea fan neovascularisation and left eye with organising vitreous haemorrhage), we recently found a surprising association with significant secondary hyphaema on the fifth day post injection in the eye with vitreous haemorrhage. After 4 weeks, there was a dramatic fibrotic resolution of the stage 3 sea fan in the other eye. Systemic bevacizumab as used in the management of colorectal cancer has been associated with bleeding diathesis in some cases, as well as with deep venous thrombosis. The rheological profile of bevacizumab is not clear-cut at the moment and the drug should therefore be used with caution in cases of stage 4 PSR.