posterior capsule opacification ( pco ) , anterior capsule phimosis , severe inflammation ( fibrinous exudates and membrane ) , cystoid macular edema , and exacerbation of diabetic retinopathy are a few of the most important postoperative complications ( krupsky et al 1991 ; chung et al 2002 ; hayashi et al 2002 ; hauser et al 2004 ; ivancic et al 2005 ; ebihara et al 2006 ) . however the progression to a proliferative state is a common condition in these patients , finding new vessels behind the posterior capsule is a rare event . the term ,  rubeosis capsulare  , coined by eifrig and colleagues ( 1990 ) is used to address this condition . the role of the vascular endothelial growth factor ( vegf ) in the pathogenesis of ischemic retinopathies is well known . it is a key factor in the development of retinal vascularization and its blockade has been related with rapid regressions of retina and iris new vessels secondary to proliferative diabetic retinopathy ( avery et al 2006 ) . bevacizumab ( avastin ; genentech , inc , south san francisco , ca , usa ) is a full - length humanized anti - vegf monoclonal antibody , approved in the united states for the treatment of metastatic colorectal cancer . it has been used in ophthalmology as an off - label treatment of choroidal neovascularization , central retinal vein occlusion , and proliferative diabetic retinopathy , with encouraging preliminary results ( yang et al 2003 ; bakri et al 2007 ) . we reported ; a case of posterior capsule neovascularization in a diabetic patient who presented adequate regression of the new vessels with intravitreal bevacizumab , allowing us to perform a successful nd : yag capsulotomy without serious complications . a 75-year - old diabetic male was attended in our department with referral to slow progressive visual loss in both eyes since 2 years prior . he had relevant medical history of long standing type 2 diabetes mellitus , high blood pressure , and amputation of the left inferior limb due to a severe infection . the patient also had history of extracapsular cataract extraction with intraocular lens ( iol ) , implantation without complications three years before the first symptom , and proliferative diabetic retinopathy treated with panretinal photocoagulation in both eyes . in the physical examination , the patient had visual acuity of count fingers in the right eye ( od ) and 20/100 in the left eye ( os ) . we offered the patient an off - label treatment with intravitreal bevacizumab in the right eye . five days after the treatment , there was a notorious decrease in the posterior capsule neovascularization . one month after , the neovascularization continued , we chose to give a second dose of intravitreal bevacizumab to our patient . two weeks after the second dose , there was no apparent neovascularization in the posterior capsule . , the patient had a small bleed ( figure 2 ) , forming a clot that slowly disappeared 2 weeks after laser treatment . the final best corrected visual acuity in od was 20/200 and 20/20 in os with a clear visual axis ( figure 3 ) . a persistent macular edema and active proliferative diabetic retinopathy was seen in the fluorescein angiography . the incidence of pco varies widely , depending on the cataract surgery technique , iol material , edge design , history of intraocular inflammation , patient age , the presence of pseudoexfoliation before surgery , among others . nevertheless , diabetes mellitus has been known historically , as a definitive risk factor ( schaumberg et al 1998 ; edihara et al 2006 ) . pco in diabetic patients undoubtedly interferes with postoperative fundoscopy , retinal photocoagulation treatment and vitrectomy , so it is important to maintain a clear visual axis . while some authors state that there is a definite progression , others state the opposite . they said that the progression seen after surgery is only the disease natural history ( murtha et al 2007 ) . the progression of diabetic retinopathy after cataract surgery includes the development of abnormal new vessels in the vitreous of untreated or insufficiently treated patients , macular edema , neovascular glaucoma and rubeosis iridis ( ivancic et al 2005 ) . in this particular case , to our knowledge , there are only four reported cases in the literature of posterior capsule neovascularization after cataract surgery . the neovascularization was related to prior surgeries ( pneumatic retinopexy and pars plana vitrectomy ) . the cases , until now reported , have been treated with vitrectomy and endophotocoagulation , intravitreal bevacizumab , and photodynamic therapy . there are no well defined treatments for this rare complication ( eifrig et al 1990 ; ayata et al 2007 ; eren et al 2007 ) . the other reported case , in which the patient was also treated with intravitreal bevacizumab , the detection of the new vessels behind the posterior capsule was done only one year after the surgery . one week after the treatment they performed a nd : yag capsulotomy with no complications . during the follow - up time of four weeks the patient did not present any complications ( eren et al 2007 ) . in our case , a single intravitreal injection of bevacizumab was not enough to induce an adequate regression of the posterior capsule neovascularization , so a second intravitreal injection was necessary to further decrease it and allow us to perform a nd : yag capsulotomy . during the procedure we had a small bleed , which slowly reduce until its complete disappearance , allowing a clear visual axis . we consider that a longer follow - up time is needed to assure that there is no recurrence of new vessels in the remaining posterior capsule that can impair the visual acuity . if the nd : yag capsulotomy would have been implemented without prior administration of the intravitreal bevacizumab , the vessels behind the posterior capsule would have been patent at the moment of the laser treatment . in this particular scenario , the risk of a major vitreous hemorrhage with the subsequent loss of vision and even an increase of the iop is very high . in summary , intravitreal bevacizumab was an effective and safe treatment that induces regression of posterior capsule neovascularization that allowed us to perform a nd : yag capsulotomy with minimal complications .
we reported a 75-year - old diabetic man , who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation . 
 the patient was treated with two injections of 2.5 mg of intravitreal bevacizumab . 
 the treatment produced an important regression of the posterior capsular new vessels , allowing us to perform a successful nd : yag capsulotomy , clearing the visual axis and improving the visualization of the posterior pole . 
 even though , best corrected visual acuity was 20/200 due to diabetic macular edema .