Ophthalmology, Kinan Hospital, 4750 Atawa, Mihama-cho, Minaminuro-gun 519-5293, Japan.
Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi 514-8507, Japan.
Medicina (Kaunas). 2023 Oct 19;59(10):1856. doi: 10.3390/medicina59101856.
: Brolucizumab (IVBr) is a recently introduced anti-vascular endothelial growth factor (anti-VEGF) which has been found to be very effective in treating neovascular age-related macular degeneration (nAMD). We reported our findings in a case of nAMD that developed intraocular inflammation (IOI) after IVBr injections. : A 79-year-old man was referred to our hospital complaining of reduced vision in both eyes of one-month's duration. His decimal best-corrected visual acuity (BCVA) was 0.9 in the right eye and 1.0 in the left eye. He was diagnosed with nAMD in the left eye and was treated with intravitreal aflibercept (IVA). Despite the three-monthly IVA injections, the serous retinal pigment epithelial detachment (PED) and subretinal fluid (SRF) remained, and the VA gradually decreased to 0.1. Because of the patient being refractory to aflibercept treatment, we switched to 3-monthly IVBr injections. The BCVA gradually improved to 0.3 and optical coherence tomography (OCT) showed an absence of the serous PED and SRF. Three weeks after his third IVBr, he returned to our hospital with a complaint of reduced vision in his left eye that he first noted two weeks earlier. Our examination of the left eye showed signs of IOI mainly in the anterior chamber. The inflammation improved with topical steroids but the treatment of the IOI was delayed for two weeks. The patient was instructed that it was important to begin the treatment as soon as the symptoms of IOI developed. We then performed the Mini-Mental State Examination (MMSE), and his score indicated that he had cognitive impairment. : We concluded that before beginning IVBr treatment in nAMD patients, a careful assessment must be made of the cognitive status of the patient.
: 布罗鲁单抗（IVBr）是一种最近引入的抗血管内皮生长因子（anti-VEGF）药物，已被证明在治疗新生血管性年龄相关性黄斑变性（nAMD）方面非常有效。我们报告了一例 nAMD 病例，该患者在接受 IVBr 注射后出现眼内炎症（IOI）。 : 一名 79 岁男性因双眼视力下降一个月到我院就诊。他的右眼十进制最佳矫正视力（BCVA）为 0.9，左眼为 1.0。他被诊断为左眼 nAMD，并接受了玻璃体内阿柏西普（IVA）治疗。尽管每三个月进行一次 IVA 注射，但浆液性视网膜色素上皮脱离（PED）和视网膜下液（SRF）仍然存在，视力逐渐下降至 0.1。由于患者对 aflibercept 治疗反应不佳，我们改用每三个月注射一次 IVBr。BCVA 逐渐提高至 0.3，光学相干断层扫描（OCT）显示浆液性 PED 和 SRF 消失。在第三次 IVBr 注射后 3 周，他因左眼视力下降返回我院，他在两周前首次注意到左眼视力下降。我们对左眼进行检查，发现主要在前房有眼内炎症的迹象。炎症在局部使用皮质类固醇后得到改善，但眼内炎症的治疗延迟了两周。患者被指示，一旦出现眼内炎症的症状，就必须尽快开始治疗。然后我们进行了简易精神状态检查（MMSE），他的得分表明他有认知障碍。 : 我们得出结论，在开始用 IVBr 治疗 nAMD 患者之前，必须仔细评估患者的认知状态。
