a 70-year - old patient with a 4-year history of neovascular glaucoma due to ischemic retinopathy in the left eye and vertigo visited our hospital after having received the maximal medical therapy for intraocular pressure ( iop ) control and panretinal photocoagulation ( prp ) at another facility . he had experienced a total lack of light perception in the left eye for 3 years and his iop was 30 mmhg . slit lamp examination demonstrated 6 clock hours of angle neovascularization with synechiae in left eye ( fig . 1 ) . indirect ophthalmoscopy revealed narrowing and ghost retinal vessels and a pale optic disc . we diagnosed the patient with ocular ischemic syndrome and treated him with the maximal tolerable medical therapy ( timolol and brimonidine , oral acetazolamide and intravenous mannitol ) for 7 days , but his iop remained high ( 27 - 38 mmhg ) . the use of bevacizumab was discussed as an alternative after fully explaining its experimental status for ocular neovascular disease . the patient opted for intravitreal bevacizumab ( avastin ) injection and signed a consent form out - lining the risk factors , possible side effects , and experimental status of the medication . we injected 1.25 mg/0.05ml of bevacizumab into the vitreous cavity of the patient 's left eye . one day after intravitreous injection of bevacizumab , the neovascularization of the iris had almost completely resolved ( fig . 3 ) , but the anterior synechiae remained . in addition , iop was 33 mmhg and his visual acuity was unchanged . after 2 days , the patient underwent left carotid artery stent insertion for severe left carotid artery stenosis . he was treated with intravenous mannitol and oral acetazolamide , which resolved the ocular pain and reduced the patient 's iop to 22 mmhg . after 7 days of injection , we started treatment with prp on the left eye . his iop was unchanged and the regression of neovascularization of the iris persisted . at 10 days , the regression of neovascularization was still present and the iop was unchanged at 33 mmhg . since there was no longer any ocular pain and light perception had returned , no additional surgery was planned . after 8 months , the ocular pain had not returned . ocular ischemic syndrome occurs secondary to severe carotid artery obstruction and involves ocular signs and symptoms including corneal edema , rubeosis iridis , neovascular glaucoma , hypoperfusion retinopathy , and choroidal perfusion disturbance . neovascular glaucoma is a devastating complication caused by ischemic retinopathy secondary to carotid artery occlusion . vegf plays a central role in ocular pathologies characterized by neovascularization and increased vascular permeabillty.3 the standard treatment includes retinal photocoagulation and cyclodestructive or drainage procedures . in this case , panretinal photocoagulation ( prp ) was completed to decrease the constant rate of vegf secretion and stop the neovascular drive . however , in spite of prp , the iop remained high . bevacizumab is a recombination of humanized anti - vegf igg1 approved as an antiangiogenic agent for the treatment of metastatic colorectal cancer in combination with chemotherapy.4 it has the effect of reversing neovascularization by controlling vegf . a recent studiy proposed using bevacizumab intravitreally for age - related macular degeneration.5 in the present case , 24 hours after treatment we saw a dramatic reduction of iris neovascularization , and no relapse was seen within a follow - up time of 10 days . iop was still high ( 22 - 33 mmhg ) , however , probably due to chronic nvg with synechiae . other case reports suggest that a single injection of bevacizumab was associated with medically controlled for at least 6 weeks.6 however , treatment with bevacizumab seems to have a fast , potent effect on neovascular pathologic correlates . in conclusion , bevacizumab may be a valuable adjunct in treating neovascular glaucoma , though further studies are needed to outline optimal time , doses , and patient selection .
we report a case of ocular ischemic syndrome accompanied by neovascular glaucoma that was successfully treated with bevacizumab . 
 a 70-year - old male patient diagnosed with neovascular glaucoma of the left eye 3 - 4 years prior complained of continuous left eye pain and declining visual acuity despite receiving the latest treatment methods . at the time of admission 
 the patient had no light perception in the left eye and his intraocular pressure was 30 mmhg . 
 anterior segment and fundus examinations revealed neovascularization of the iris and stenosis of the retinal vessel . 
 hypofluorescence of the choroid and retinal vessels was observed on fluorescence fundus angiography . 
 left internal carotid artery stenosis was observed on a brain mri . despite being treated with eye solution and oral medication , intraocular pressure was not controlled . 
 after 7 days , we performed an intravitreal bevacizumab 1.25 mg/0.05ml injection . 
 one day after the intravitreal bevacizumab injection , the neovascularization had nearly regressed and intraocular pressure was 30 mmhg . 
 intravitreal bevacizumab injection produced regression of neovascularization and proved effective for treatment of neovascular glaucoma in this case of ocular ischemic syndrome .