Resolution of Refractory Corneal Neovascularization with Sub
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A 63-year-old woman was referred for ophthalmic review of blurred vision and found to have ocular pannus and rosacea. Her medical history was positive for acne rosacea, previously treated with doxycycline and tobramycin. Other past medical history included hyperthyroidism; family history was unknown. Her visual acuity (VA) was 6/12-2 in the right eye and 6/12 in the left eye. Intraocular pressure was 8 and 9 mm Hg, respectively. There was CNV bilaterally, up to the edge of the pupil on the left and 50% encroaching on the pupil on the right. Conjunctiva, anterior chamber, and iris examination were normal. Examination of the lens revealed a 2+ nuclear sclerosis cataract bilaterally. A diagnosis of CNV secondary to ocular rosacea was made and the patient was commenced on fluorometholone drops twice daily and 100 mg oral doxycycline daily for 3 months.

Over the following year and a half, the patient was reviewed at 3- to 5-monthly intervals. She had poor compliance with fluorometholone as she felt it caused irritation. Corneal examination revealed scarring in an inferotemporal distribution bilaterally, with stromal vessels on the right and ghost vessels on the left. She was also found to have blepharitis and was recommended warm compresses to lids daily. Across this time period, dexamethasone drops were trialed in place of fluorometholone. She was continued on oral doxycycline 50 mg daily and lubricant drops. At each follow-up, the corneal examination was worsening with increased vessels bilaterally. VA worsened to 6/18 bilaterally, then to 6/36 for the right eye at one review and the patient was interested in an alternative to the current medications.

Almost 2 years after initial presentation, the patient was given 1.5 mg of subconjunctival bevacizumab to both eyes. At a 1-month follow-up, VA was 6/9-3 on the right and 6/12 with a pinhole on the left. A review of the conjunctiva revealed decreased injection and a reduction in inferior temporal stromal vessels. A month later, the patient received a further 1.5 mg subconjunctival bevacizumab bilaterally. She was prescribed 3 months of further dexamethasone and 6 months of further fluorometholone, ocular lubricant drops, and doxycycline. She did not present for her scheduled follow-up review as planned and was not seen until referred by her general practitioner for follow-up in 2020, 4 years following the last injection. During this time, the patient admitted ceasing doxycycline tablets, and it is unclear whether she continued on the dexamethasone or fluorometholone drops. Her general practitioner did not prescribe any more of these medications, so at best she had a limited supply of each of these. At the review 4 years following the last bevacizumab injection, corneal examination revealed a maintained reduction in stromal and ghost vessels bilaterally. The patient was no longer continuing any ocular medication besides ocular lubricant drops as needed. VA was 6/12 bilaterally, improving to 6/9 on the right with a pinhole.