Intravitreal bevacizumab causes rapid regression of disc neovascularization associated with large optic disk melanocytoma: a case report

Optic disk melanocytoma (ODM) is a rare ophthalmic tumor that can present with local compressive effects such as retinal vascular occlusion (RVO) that results in neovascularization of the disk (NVD) and is reportedly challenging to treat. We report the case of a 37-year-old Black African male with a two-year history of painless nonprogressive blur in his right eye vision. Findings on ocular examination include best corrected visual acuity right eye 6/18 and left eye 6/6, right eye relative afferent pupillary defect, and a large dark brown pigmented mass covering the optic disc measuring 4.8 mm x 4.6 mm. NVD was present along the superior disc margin and whitening of the superotemporal retinal vessels. Fluorescein angiography confirmed a superotemporal retinal vascular occlusion with non-perfusion and dye leakage from the NVD. Intravitreal bevacizumab and scatter retinal laser resulted in complete NVD regression within four weeks and no recurrence in 18 months. This case report suggests that earlier treatment with Intravitreal bevacizumab and scatter retinal laser photocoagulation is effective for the regression and stabilization of NVD associated with ODM. Aggressive ODM could be a feature in younger-age Africans. Yearly monitoring is required to detect an increase in ODM size that could suggest malignant transformation.