Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan.
Manhattan Retina and Eye Consultants, New York, NY.
Medicine (Baltimore). 2021 Oct 22;100(42):e27580. doi: 10.1097/MD.0000000000027580.
Brolucizumab is a novel anti-vascular endothelial growth factor agent with clinical trials demonstrating excellent efficacy for neovascular age-related macular degeneration (AMD) in both visual and anatomic outcomes. However, there is concern of intraocular inflammation (IOI), and we propose concurrent subtenon triamcinolone acetonide (STTA) to prevent IOI.
A 73-year-old man was treated with aflibercept for neovascular AMD in his right eye. Despite 11 months of monthly intravitreal aflibercept injections, optical coherence tomography demonstrated persistent exudation. Ten days following his second brolucizumab injection, the patient presented with decreased vision due to vitritis in his right eye.
Brolucizumab-related IOI in neovascular AMD refractory to aflibercept.
A combination therapy involving of intravitreal brolucizumab and STTA.
The anti-vascular endothelial growth factor inhibitor was changed back to aflibercept; however, exudation persisted. Therefore, a combination therapy involving STTA (5 mg/0.5 mL) and intravitreal injection of brolucizumab (6.0 mg/0.05 mL) was performed to treat the exudation and as prophylaxis to recurrent IOI. Combination therapy achieved no recurrent IOI and resolution of exudation with 8-week treatment intervals.
This case might indicate that STTA is not only an optimal treatment option for brolucizumab-related IOI but also a preventive agent for this condition.
布罗鲁单抗是一种新型的抗血管内皮生长因子药物，临床试验表明其在治疗新生血管性年龄相关性黄斑变性（AMD）方面具有出色的疗效，在视力和解剖学结果方面均有显著效果。然而，人们对眼内炎症（IOI）仍存在担忧，我们建议同时使用曲安奈德前房注射（STTA）来预防 IOI。
一名 73 岁男性右眼患有新生血管性 AMD，接受阿柏西普治疗。尽管每月接受玻璃体腔内注射阿柏西普治疗了 11 个月，但光学相干断层扫描显示仍有持续性渗出。在第二次玻璃体腔内注射布罗鲁单抗后 10 天，患者因右眼葡萄膜炎导致视力下降。
新生血管性 AMD 对阿柏西普治疗产生耐药后发生布罗鲁单抗相关 IOI。
采用玻璃体内注射布罗鲁单抗联合 STTA 的联合治疗。
将抗血管内皮生长因子抑制剂换回阿柏西普；然而，渗出仍持续存在。因此，采用了包括 STTA（5mg/0.5mL）和玻璃体内注射布罗鲁单抗（6.0mg/0.05mL）的联合治疗方案来治疗渗出，并预防 IOI 的复发。联合治疗方案在 8 周的治疗间隔内，未出现复发性 IOI，渗出也得到了缓解。
该病例可能表明，STTA 不仅是治疗布罗鲁单抗相关 IOI 的最佳选择，也是预防这种情况的药物。
