Possible necrotizing scleritis and non‐infectious vitritis following intravitreal injection of bevacizumab

Aims/Purpose: This case report describes possible necrotizing scleritis and non‐infectious vitritis in the right eye following intravitreal injections of bevacizumab for the treatment of postsurgical cystic macular edema, highlighting the potential immune‐mediated adverse reactions associated with the intravitreal treatment. Methods: An ophthalmological examination was performed along with laboratory and imaging tests to diagnose the patient. Results: After the first injection, the patient developed intense ocular redness, scleral thinning, and pancorneal punctate keratitis, with possible necrotizing scleritis suspected. Treatment was iniciated with a positive progress, however, after resuming the treatment with bevacizumab due to persistence of macular edema, the patient experienced blurred vision and photophobia, and mild vitritis was observed during the examination. Topical treatment produced rapid improvement, but due to suspicion of an immune‐mediated reaction, bevacizumab was discontinued. Alternative treatments were considered, including other anti‐VEGF agents and topical anti‐inflammatory medications. Conclusions: Although necrotizing scleritis is not described as a possible adverse reaction to treatment with intravitreal bevacizumab, its association with another immune‐mediated reaction that also coincides in time with the treatment suggests a possible causal relationship. This case highlights the importance of recognizing and managing rare immune‐related adverse reactions to intravitreal treatments, emphasizing the need for alternative therapies that minimize risks to the patient.