Garweg Justus G, Blum Claudine A, Copt René-Pierre, Eandi Chiara M, Hatz Katja, Prünte Christian F, Seelig Eleonora, Somfai Gábor M
Berner Augenklinik, Zieglerstrasse 29 (Y), 3012, Bern, Switzerland.
Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
Ophthalmol Ther. 2023 Apr;12(2):639-655. doi: 10.1007/s40123-023-00647-7. Epub 2023 Jan 12.
Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.
抗血管内皮生长因子（anti-VEGF）疗法已成为治疗新生血管性年龄相关性黄斑变性（nAMD）和糖尿病性黄斑水肿（DME）的标准治疗方法，显著减少了与疾病相关的视力丧失。然而，需要定期注射给患者、护理人员和医疗系统带来了沉重负担，而且视力改善可能无法长期维持。由于其干燥效力和作用持续时间，布罗鲁单抗（一种被批准用于治疗nAMD和DME的玻璃体内抗VEGF疗法）可以减少患者的注射频率并提供有效的治疗；然而，平衡其益处和风险可能具有挑战性。有报道称，接受布罗鲁单抗治疗的患者出现了眼内炎症（IOI），如果不进行治疗，可能会导致严重的视力丧失。然而，最近的证据表明，在这些相对罕见但严重的病例中，早期识别IOI并对后段受累情况迅速积极地进行全身皮质类固醇治疗可带来良好的结果。2022年，瑞士医学视网膜专家和糖尿病专家召开了一系列共识会议，讨论了布罗鲁单抗的现有数据，并探讨了其使用面临的各种挑战，包括IOI的相关风险。其结果是为眼科医生整理了关于在nAMD和DME患者中使用布罗鲁单抗的实用见解和指导，包括患者选择和评估、治疗方案和监测以及不良事件的识别和管理。
