Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Ophthalmology, Yokkaichi Municipal Hospital, Mie, Japan.
Jpn J Ophthalmol. 2021 Mar;65(2):199-207. doi: 10.1007/s10384-021-00818-8. Epub 2021 Feb 5.
To describe three Japanese cases of retinal vasculitis that occurred following intravitreal brolucizumab injections and the systemic and local steroid treatment administered.
Three patients developed intraocular inflammation (IOI) and retinal vasculitis following the first injection of brolucizumab for age-related macular degeneration. For two eyes, monthly aflibercept injections did not control exudation, and therapy was changed to brolucizumab; one eye was treatment-naïve. All three patients noticed blurry vision and floaters 11-18 days after brolucizumab injections, and the treated eyes exhibited anterior chamber cells, fine keratic precipitates, vitreous cells, and vitreous haze. Ultra-widefield color images of the fundus showed retinal hemorrhage in the peripheral retina and, in two cases vascular sheathing. Ultra-widefield fluorescein angiography (FA) showed segmental vascular leakage in all eyes and leakage from the optic disc in two eyes. Vascular filling defects were noted in the peripheral retinae of two eyes. Brolucizumab-associated retinal vasculitis was diagnosed, and treated with 30 mg/day of oral prednisolone, subtenon triamcinolone acetonide injection (20 mg/0.5 ml), and 0.1% betamethasone sodium phosphate solution. After 1 week, color fundus images and FA showed improvements in vascular sheathing, leakage from retinal vessels, and optic disc leakage, but the vascular filling defects remained. Visual acuity was restored in all three eyes 6 weeks after the onset.
Brolucizumab-associated IOI, including retinal vasculitis and retinal occlusion, is a rare but important adverse event that can cause severe vision loss. Prompt diagnosis with FA and treatment with systemic or local steroids should be considered.
描述三例日本患者在接受玻璃体内注射布鲁单抗后发生的视网膜血管炎，并对其进行全身性和局部类固醇治疗。
三例患者在接受布鲁单抗治疗年龄相关性黄斑变性的首次注射后出现眼内炎症（IOI）和视网膜血管炎。对于两只眼睛，每月的阿柏西普注射不能控制渗出，因此改为布鲁单抗治疗；其中一只眼睛为初治。所有三例患者在接受布鲁单抗注射后 11-18 天均出现视力模糊和漂浮物，治疗眼出现前房细胞、细角膜沉淀物、玻璃体细胞和玻璃体混浊。眼底超广角彩色图像显示周边视网膜出血，两例有血管鞘。所有眼睛的超广角荧光素血管造影（FA）均显示节段性血管渗漏，两例有视盘渗漏。两例眼底周边可见血管充盈缺损。诊断为布鲁单抗相关的视网膜血管炎，给予 30mg/天的口服泼尼松龙、玻璃体内曲安奈德（20mg/0.5ml）和 0.1%磷酸倍他米松钠溶液治疗。1 周后，彩色眼底图像和 FA 显示血管鞘、视网膜血管渗漏和视盘渗漏改善，但血管充盈缺损仍然存在。发病后 6 周，所有三例视力均恢复。
布鲁单抗相关的 IOI，包括视网膜血管炎和视网膜阻塞，是一种罕见但重要的不良反应，可导致严重的视力丧失。应及时通过 FA 进行诊断，并考虑全身性或局部类固醇治疗。
