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74-year-old man with hypertension and diabetes mellitus presented with a three-month history of intermittent orbital pain and progressive vision loss in his left eye, deteriorating to hand motions. The intraocular pressure was in the normal range at 13 mm Hg. Biomicroscopy showed prominent iris neovasculature (Figure 1A). Fluorescein angiography disclosed dot hemorrhages in the midperipheral retina, as well as delayed choroidal and retinal perfusion, indicating fundus ischemia. Intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor agent, achieved rapid regression of iris neovasculature within six days (Figure 1B). For iris neovasculature without retinal vascular diseases, ocular ischemic syndrome should be considered, and total occlusion of the left internal carotid artery was shown on carotid duplex ultrasonography and angiography. Subsequent angioplasty with stenting restored the blood flow (see Appendix 1, available at www.cmaj.ca/lookup/suppl/

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