Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, Inashiki, Ibaraki, Japan.
Medicine (Baltimore). 2024 Oct 18;103(42):e40154. doi: 10.1097/MD.0000000000040154.
Brolucizumab is an anti-vascular endothelial growth factor agent. Clinical trials have demonstrated excellent efficacy of brolucizumab for neovascular age-related macular degeneration in terms of both visual and anatomic outcomes. However, compared with conventional anti-vascular endothelial growth factor therapy, this new treatment has a higher incidence of complications, particularly the development of occlusive retinal vasculitis. In this case report, we describe a patient who developed occlusive retinal vasculitis following brolucizumab treatment for age-related macular degeneration, followed by scleritis 141 days later.
A 67-year-old Japanese man with a diagnosis of polypoidal choroidal vasculopathy in his right eye has received 18 intravitreal injections of aflibercept in the past 4 years. Because of a decline in treatment efficacy, intravitreal brolucizumab injection (IVBr) was initiated. However, 17 days after the second IVBr, the patient developed extensive occlusive retinal vasculitis with intraocular inflammation.
Occlusive retinal vasculitis in the right eye was diagnosed as a complication of brolucizumab therapy.
Corticosteroid treatment was initiated.
The occlusive retinal vasculitis resolved 121 days after the second IVBr, and corticosteroid treatment was discontinued on day 138. However, on day 158 after the second IVBr, scleritis with intraocular inflammation developed. By day 184 after the second IVBr, both the scleritis and intraocular inflammation had resolved with the resumption of topical corticosteroid treatment.
This case underscores the potential for brolucizumab-induced scleritis and emphasizes the importance of recognizing and promptly managing this complication. Furthermore, it highlights the need for long-term careful follow-up in patients who develop occlusive retinal vasculitis after brolucizumab treatment.
Brolucizumab 是一种抗血管内皮生长因子药物。临床试验表明，brolucizumab 在治疗新生血管性年龄相关性黄斑变性方面，无论是在视力还是解剖学方面都具有出色的疗效。然而，与传统的抗血管内皮生长因子治疗相比，这种新的治疗方法具有更高的并发症发生率，特别是闭塞性视网膜血管炎的发展。在本病例报告中，我们描述了一位患者在接受 brolucizumab 治疗年龄相关性黄斑变性后出现闭塞性视网膜血管炎，141 天后又发生巩膜炎。
一位 67 岁的日本男性，右眼诊断为息肉状脉络膜血管病变，过去 4 年中已接受了 18 次玻璃体内注射抗血管内皮生长因子药物。由于治疗效果下降，开始接受玻璃体内注射 brolucizumab（IVBr）。然而，在第二次 IVBr 后 17 天，患者出现广泛的闭塞性视网膜血管炎伴眼内炎症。
右眼闭塞性视网膜血管炎被诊断为 brolucizumab 治疗的并发症。
开始皮质类固醇治疗。
第二次 IVBr 后 121 天，闭塞性视网膜血管炎消退，第二次 IVBr 后 138 天停止皮质类固醇治疗。然而，第二次 IVBr 后 158 天，发生伴有眼内炎症的巩膜炎。第二次 IVBr 后 184 天，在恢复局部皮质类固醇治疗后，巩膜炎和眼内炎症均得到缓解。
本病例强调了 brolucizumab 诱导巩膜炎的潜在风险，并强调了及时识别和处理这种并发症的重要性。此外，它还强调了对接受 brolucizumab 治疗后发生闭塞性视网膜血管炎的患者进行长期密切随访的必要性。
