Background: Intravitreal brolucizumab (IVBr) is associated with a higher incidence of intraocular inflammation (IOI) than other antivascular endothelial growth factor agents. Herein, we describe two patients who experienced IOI recurrence after their symptoms tended to improve in response to injection of sub-Tenon triamcinolone acetonide (STTA).
Cases: Case 1 involved a 67-year-old man who started receiving treatment with IVBr after being diagnosed with polypoidal choroidal vasculopathy in the right eye. Twelve days after initial IVBr treatment, iritis, vitritis, and retinal phlebitis developed, leading to a diagnosis of brolucizumab-related IOI, which required subsequent STTA administration. Although IOI tended to improve with STTA administration, iritis and vitritis recurred, and new retinal arteriovenous inflammation developed 2 months after the initial treatment. Additional STTA was administered to address the recurrent IOI, resulting in resolution of the inflammation. Case 2 involved a 75-year-old man who started receiving treatment with IVBr after being diagnosed with pachychoroid neovasculopathy in the left eye. One month after initial IVBr treatment, iritis, vitritis, and retinal arteritis developed, leading to a diagnosis of brolucizumab-related IOI, which required subsequent STTA administration. Although the IOI tended to improve with STTA administration, iritis recurrence and new retinal arteritis were noted 5 months after the initial treatment. Additional STTA was administered to treat the recurrent IOI, resulting in resolution of the inflammation.
Conclusion: Brolucizumab-related IOI should be carefully monitored as inflammation may recur a few months after STTA administration.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 128：348-355, 2024.