Rubeosis occurs in eyes with history of complex retinal detachments that are injected with SO due to persistent peripheral annular detachments.1
IOLs may become incorporated into anterior PVR membranes. Vascular endothelial growth factor (VEGF) released by ischaemic tissues such as the retina is implicated in the development of rubeosis and was released by ischaemic RRF. Therefore, anti-VEGF agents have a role.
Ranibizumab is a humanised antigen binding fragment designed to inhibit all isoforms and active degradation products of VEGF-A.2
Since its development as an effective treatment for age related macular degeneration, intravitreal ranibizumab has been proposed for various other retinal vascular diseases associated with increased VEGF such as diabetic retinopathy, central retinal vein occlusion, and rubeosis. A number of case series have documented the effectiveness of bevacizumab (Avastin, Genentech Inc, San Francisco, USA), a sister compound to ranibizumab, in causing regression of rubeosis.3,4
Ranibizumab caused regression of rubeosis in a patient with radiation induced neovascular glaucoma and exudative retinal detachment.5
However, to our knowledge, the role of ranibizumab in a non-diabetic patient with rubeosis secondary to RRF has not been documented previously and articles on its role in rubeosis are limited.
Ranibizumab was injected intracamerally as the retinal ischaemia was deemed to be limited to the anterior segment. This technique also avoided needle passage through possible anterior PVR. The concentration of ranibizumab and its diffusibility in silicone oil is uncertain. However, there is a safety issue of intracameral injection of ranibizumab, especially in the context of a silicone filled eye, where the aqueous compartment may be notably reduced depending on the level of oil fill. Bevacizumab is safe when injected intracamerally.3,6
- Ranibizumab has a role in causing rapid regression of rubeosis in cases of RRF in non-diabetic eyes filled with silicone oil.
- Ranibizumab did not have obvious side effects when injected intracamerally.
- Ranibizumab has an adjunctive role in reducing intraoperative bleeding in eyes with rubeosis in the setting of RRF and silicone oil that are undergoing vitreo-retinal surgical procedures.