Vitreous Web after Pars Plana Vitrectomy and Bevacizumab with Fluid-Air Exchange

Background: Intravitreal bevacizumab may result in intraocular inflammation of infectious and non-infectious etiology. Appropriate recognition of a sterile process can circumvent unnecessary treatment for endophthalmitis. Design: Observational case report. Methods: A marked web-like inflammatory response within the vitreous following intraoperative intravitreal bevacizumab is described in a patient with pre-proliferative diabetic retinopathy, macular edema, and epiretinal membrane who underwent pars plana vitrectomy, membrane peel, endolaser, and fluid-air exchange. Wide-field fundus photography captured the full extent of this reaction. Results: On post-operative day one, the patient presented with vitreous opacities in the form of a web of multiple white strands inferior to an air bubble, with minimal anterior or vitreous cell. At one week, the inflammatory reaction had completely resolved. Conclusion: Existing reports of intraocular inflammation following intravitreal bevacizumab range from uveitis to infectious endophthalmitis. With wide-field fundus imaging, we report an acute, marked web-like inflammatory response following intraoperative intravitreal bevacizumab that resolved spontaneously.