Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
Vitreous, Retina, Macula Consultants of New York, New York, New York.
Ophthalmology. 2020 Oct;127(10):1345-1359. doi: 10.1016/j.ophtha.2020.04.017. Epub 2020 Apr 25.
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.
Retrospective case series.
Fifteen eyes from 12 patients identified from 10 United States centers.
Review of patient demographics, ophthalmologic examination results, and retinal imaging findings.
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.
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).
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.
评估玻璃体内注射（IVI）6mg/0.05ml 布罗利珠单抗治疗新生血管性年龄相关性黄斑变性后出现视网膜血管炎和眼内炎症（IOI）的特征和结果。
回顾性病例系列。
从 10 个美国中心的 12 名患者中确定的 15 只眼。
回顾患者的人口统计学、眼科检查结果和视网膜成像发现。
基线和随访视力（VA）、之前的抗血管内皮生长因子（VEGF）注射、临床表现、视网膜表现、荧光素血管造影结果和治疗策略。
在改用布罗利珠单抗之前，受累眼的抗 VEGF-IVI 次数在 2 到 80 次之间不等。在布罗利珠单抗 IVI 后平均 30 天诊断出视网膜血管炎和 IOI。在接受布罗利珠单抗 IVI 之前，平均 VA 为 0.426 对数最小角分辨率（logMAR；Snellen 等价物，20/53），在诊断出视网膜血管炎时为 0.981 logMAR（Snellen 等价物，20/191；范围，20/25-20/1600；P=0.008）。所有受累眼均出现 IOI，表现为局灶性或节段性鞘膜和小、大视网膜动脉连续性中断、动脉硬化、无灌注区、棉絮斑、Kyrieleis 斑块、静脉口径不规则伴扩张和硬化段、静脉周围出血和静脉炎灶。荧光素血管造影显示视网膜动脉充盈延迟、视网膜血管无灌注和受累血管和视神经的染料渗漏。2 例患者的系统性栓塞病因评估无明显异常，3 例患者的葡萄膜炎实验室检查结果为阴性。治疗包括皮质类固醇（全身、玻璃体内和局部）的各种组合，2 只眼接受玻璃体切除术，但视力无改善。平均随访 25 天后，平均 VA 为 0.833 logMAR（Snellen 等价物，20/136），与基线相比有所下降（P=0.033）。
布罗利珠单抗 IVI 后出现的视网膜血管炎和 IOI 表现为大或小视网膜动脉或两者同时闭塞，并伴有血管周围异常。它可能从周边血管炎发展为视神经或黄斑周围大视网膜动脉闭塞，导致严重视力丧失。由于玻璃体细胞可能会掩盖视网膜细节的可视化，因此需要高度怀疑。
