Abstract

Volume.125 Number.9

Original article : Clinical science

Intraocular Inflammation in Patients with Aflibercept Refractory Exudative Age-related Macular Degeneration after Switching to Brolucizumab
Akio Oishi1, Yuki Maekawa1, Eiko Tsuiki1, Akira Machida1, Yuki Hirata1, Junko Kurihara2, Takashi Kitaoka1
1 Department of Ophthalmology and Visual Sciences, School of Medicine Nagasaki University
2 Department of Ophthalmology, Japanese Red Cross Nagasaki Genbaku Hospital

Purpose: Some cases of exudative age-related macular degeneration (AMD) are not fully responsive to the existing anti-vascular endothelial growth factor (anti-VEGF) drugs. Recently developed brolucizumab exhibited superiority to aflibercept in reducing retinal thickness and may be effective in such refractory cases. However, we frequently encountered cases of intraocular inflammation after administering brolucizumab in patients with refractory AMD. We herein report these cases.
Subjects and methods: A prospective observational study was planned for patients with AMD who were administered existing anti-VEGF drugs more than three times in the preceding four months, and these drugs were later switched to brolucizumab due to persistent exudative changes. The patients were followed up 1,3, and 6 months after the start of brolucizumab administration.
Results: Brolucizumab was administered to 5 eyes of 4 patients who had been treated with aflibercept, of which 3 eyes of 3 patients developed intraocular inflammation. In all the three patients, brolucizumab was discontinued, and conservative therapy was initiated using ocular instillation and sub-Tenon injection of steroids. Consequently, the inflammation dissipated; however, cataract progressed in one patient and required surgery. Meanwhile, none of the three cases exhibited recurrences of exudative changes as of five months after the administration of brolucizumab. Given the risk-benefit balance, brolucizumab was discontinued for the other patients who did not develop intraocular inflammation.
Conclusions: Brolucizumab may be effective in suppressing exudative changes when administered to patients who are not responsive to aflibercept. However, switching to this drug may cause intraocular inflammation. Physicians should exercise caution and provide a thorough explanation to patients before deciding to introduce this drug.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 911-918,2021.

Key words
Brolucizumab, Intraocular inflammation, Age-related macular degeneration
Reprint requests to
Akio Oishi, M. D. Department of Ophthalmology and Visual Sciences, School of Medicine Nagasaki University. 1-7-1 Sakamoto, Nagasaki-shi, 852-8501, Japan