Caroline R Baumal1, Richard F Spaide2, Lejla Vajzovic3, K Bailey Freund4, Scott D Walter5, Vishak John6, Ryan Rich7, Nauman Chaudhry8, Rohit R Lakhanpal9, Patrick R Oellers10, Thellea K Leveque11, Bryan K Rutledge10, Mark Chittum7, Tommaso Bacci2, Ana Bety Enriquez12, Newman J Sund9, Eric N P Subong13, Thomas A Albini14. 1. Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts. Electronic address: cbaumal@tuftsmedicalcenter.org. 2. Vitreous, Retina, Macula Consultants of New York, New York, New York. 3. Duke University Eye Center, Durham, North Carolina. 4. Vitreous, Retina, Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University, New York, New York. 5. University of Connecticut, Farmington, Connecticut. 6. Vistar Eye Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia. 7. Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado. 8. Department of Ophthalmology, Yale University School of Medicine, New Have, Connecticut. 9. The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey. 10. Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York. 11. Department of Ophthalmology, University of Washington, Seattle, Washington. 12. Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts. 13. The Retina Group of Seattle, Seattle, Washington. 14. Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Abstract
PURPOSE: To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. DESIGN: Retrospective case series. PARTICIPANTS: Fifteen eyes from 12 patients identified from 10 United States centers. METHODS: Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME MEASURES: Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. RESULTS: The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033). CONCLUSIONS: Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
PURPOSE: To evaluate features and outcomes of eyes with retinal vasculitis and intraocularinflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. DESIGN: Retrospective case series. PARTICIPANTS: Fifteen eyes from 12 patients identified from 10 United States centers. METHODS: Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME MEASURES: Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. RESULTS: The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033). CONCLUSIONS:Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
Authors: Hong Xin; Nilima Biswas; Pin Li; Cuiling Zhong; Tamara C Chan; Eric Nudleman; Napoleone Ferrara Journal: Proc Natl Acad Sci U S A Date: 2021-05-25 Impact factor: 11.205
Authors: Mohammad Ali Sadiq; Muhammad Sohail Halim; Muhammad Hassan; Neil Onghanseng; Irmak Karaca; Aniruddha Agarwal; Rubbia Afridi; Yasir J Sepah; Diana V Do; Quan Dong Nguyen Journal: Int J Retina Vitreous Date: 2020-07-08
Authors: Rehan M Hussain; Bilal A Shaukat; Lauren M Ciulla; Audina M Berrocal; Jayanth Sridhar Journal: Drug Des Devel Ther Date: 2021-06-21 Impact factor: 4.162