Andre J Witkin1, Paul Hahn2, Timothy G Murray3, J Fernando Arevalo4, Kevin J Blinder5, Netan Choudhry6, Geoff G Emerson7, Roger A Goldberg8, Stephen J Kim9, Joel Pearlman10, Eric W Schneider11, Homayoun Tabandeh12, Robert W Wong13. 1. Tufts Medical Center, Boston, MA, USA. 2. NJ Retina, Teaneck, NJ, USA. 3. Murray Ocular Oncology and Retina, Miami, FL, USA. 4. Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, MD, USA. 5. The Retina Institute, St Louis, MO, USA. 6. Vitreous Retina Macula Specialists of Toronto, Toronto, ON, Canada. 7. Retina Center of Minnesota, Minneapolis, MN, USA. 8. Bay Area Retina Associates, Walnut Creek, CA, USA. 9. Vanderbilt University Medical Center, Nashville, TN, USA. 10. Retinal Consultants, Sacramento, CA, USA. 11. Tennessee Retina, Nashville, TN, USA. 12. Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA. 13. Austin Retina Associates, Austin, TX, USA.
Abstract
PURPOSE: To analyze a case series of retinal vasculitis reported to the American Society of Retina Specialists (ASRS) following Food and Drug Administration approval of brolucizumab for treatment of neovascular age-related macular degeneration. METHODS: The ASRS Research and Safety in Therapeutics Committee analyzed clinical and imaging characteristics from submitted reports of retinal vasculitis after brolucizumab. RESULTS: Retinal vasculitis was reported in 26 eyes of 25 patients (22 [88%] female) after treatment with brolucizumab. Imaging studies were available for 24 of 26 eyes. Most cases (92%) were associated with intraocular inflammation, which presented at a mean of 25 days (range, 3-63 days) after the most recent brolucizumab injection. Mean visual acuity (VA) was 20/52 (range, 20/25-4/200) before the adverse event, 20/151 (range, 20/25-hand motion) at presentation of the adverse event, and 20/243 (range, 20/30-light perception) at last follow-up. Twelve eyes (46%) had a greater than 3-line decrease in VA at final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse. Analysis of retinal imaging identified vasculopathy that involved retinal arteries (91%), retinal veins (79%), and choroidal vessels (48%). Occlusive disease was apparent on imaging in 83% of eyes. Treatment approaches were varied. CONCLUSIONS: Retinal vasculitis has been identified in a series of eyes following brolucizumab. Although a few eyes in this series were asymptomatic or minimally symptomatic, some eyes had significant vision loss. A careful examination for signs of active inflammation prior to brolucizumab injection is recommended. Once vasculopathy is suspected, angiographic imaging may help define the spectrum of involvement. Optimal treatment strategies remain unknown.
PURPOSE: To analyze a case series of retinal vasculitis reported to the American Society of Retina Specialists (ASRS) following Food and Drug Administration approval of brolucizumab for treatment of neovascular age-related macular degeneration. METHODS: The ASRS Research and Safety in Therapeutics Committee analyzed clinical and imaging characteristics from submitted reports of retinal vasculitis after brolucizumab. RESULTS: Retinal vasculitis was reported in 26 eyes of 25 patients (22 [88%] female) after treatment with brolucizumab. Imaging studies were available for 24 of 26 eyes. Most cases (92%) were associated with intraocular inflammation, which presented at a mean of 25 days (range, 3-63 days) after the most recent brolucizumab injection. Mean visual acuity (VA) was 20/52 (range, 20/25-4/200) before the adverse event, 20/151 (range, 20/25-hand motion) at presentation of the adverse event, and 20/243 (range, 20/30-light perception) at last follow-up. Twelve eyes (46%) had a greater than 3-line decrease in VA at final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse. Analysis of retinal imaging identified vasculopathy that involved retinal arteries (91%), retinal veins (79%), and choroidal vessels (48%). Occlusive disease was apparent on imaging in 83% of eyes. Treatment approaches were varied. CONCLUSIONS: Retinal vasculitis has been identified in a series of eyes following brolucizumab. Although a few eyes in this series were asymptomatic or minimally symptomatic, some eyes had significant vision loss. A careful examination for signs of active inflammation prior to brolucizumab injection is recommended. Once vasculopathy is suspected, angiographic imaging may help define the spectrum of involvement. Optimal treatment strategies remain unknown.
Authors: Jonathan P Greenberg; Peter Belin; John Butler; Daniel Feiler; Christian Mueller; Andrew Tye; Steven M Friedlander; Geoffrey G Emerson; Philip J Ferrone Journal: Ophthalmol Retina Date: 2019-04-11
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Authors: Pravin U Dugel; Adrian Koh; Yuichiro Ogura; Glenn J Jaffe; Ursula Schmidt-Erfurth; David M Brown; Andre V Gomes; James Warburton; Andreas Weichselberger; Frank G Holz Journal: Ophthalmology Date: 2019-04-12 Impact factor: 12.079
Authors: Paul Hahn; Mina M Chung; Harry W Flynn; Suber S Huang; Judy E Kim; Tamer H Mahmoud; SriniVas R Sadda; Pravin U Dugel Journal: JAMA Ophthalmol Date: 2015-04 Impact factor: 7.389
Authors: Andre J Witkin; Paul Hahn; Timothy G Murray; J Fernando Arevalo; Kevin J Blinder; Netan Choudhry; Geoff G Emerson; Roger A Goldberg; Stephen J Kim; Joel Pearlman; Eric W Schneider; Homayoun Tabandeh; Robert W Wong Journal: J Vitreoretin Dis Date: 2020-12-15