Asakage Masaki, Noma Hidetaka, Yasuda Kanako, Goto Hiroshi, Shimura Masahiko
Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan.
Department of Ophthalmology, Tokyo Medical University, Tokyo 160-8402, Japan.
Medicina (Kaunas). 2025 Feb 20;61(3):372. doi: 10.3390/medicina61030372.
Anti-vascular endothelial growth factor (VEGF) treatment with intravitreal brolucizumab (IVBr) was launched as a novel treatment for neovascular age-related macular degeneration (AMD), but the incidence of intraocular inflammation (IOI) as a specific adverse effect of brolucizumab has been reported. We evaluated the dynamics of inflammatory factors in AMD in patients with or without IOI before and after anti-VEGF treatment with IVBr. We describe three patients who did not develop inflammation after three consecutive administrations of IVBr and three in whom inflammation occurred after the first IVBr treatment. The presence or absence of inflammation was determined by slit-lamp examination and a laser flare meter. Aqueous humor was obtained during anti-VEGF treatment with IVBr. Levels of VEGF, platelet-derived growth factor (PDGF)-AA, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, interferon-inducible 10 kDa protein (IP-10), Fms-related tyrosine kinase 3 ligands (Flt-3L), and fractalkine were measured. Vision worsened in one patient who developed IOI after initial IVBr, so IVBr was discontinued and the patient was switched to intravitreal aflibercept with sub-tenon injection of triamcinolone acetonide. IVBr was continued in the two other patients with IOI. VEGF decreased after IVBr in all patients with and without IOI. On the other hand, at 1 month IL-6, IL-8, MCP-1, IP-10, and Flt-3L were higher in the three patients with IOI compared with baseline and with the three patients without IOI. In two patients with IOI, not only flares but also IL-8, IP-10, and Flt-3L decreased from 1 to 2 months after IVBr despite continued IVBr. This case series might lead to a better understanding of the pathogenesis of IOI after IVBr.
玻璃体内注射布罗珠单抗（IVBr）的抗血管内皮生长因子（VEGF）治疗作为新生血管性年龄相关性黄斑变性（AMD）的一种新疗法被推出，但布罗珠单抗作为一种特定不良反应的眼内炎症（IOI）发生率已有报道。我们评估了在接受IVBr抗VEGF治疗前后，有或无IOI的AMD患者炎症因子的动态变化。我们描述了3例连续3次注射IVBr后未发生炎症的患者和3例首次注射IVBr后发生炎症的患者。通过裂隙灯检查和激光 flare 仪确定是否存在炎症。在IVBr抗VEGF治疗期间采集房水。检测VEGF、血小板衍生生长因子（PDGF）-AA、单核细胞趋化蛋白1（MCP-1）、白细胞介素（IL）-6、IL-8、干扰素诱导的10 kDa蛋白（IP-10）、Fms相关酪氨酸激酶3配体（Flt-3L）和趋化因子的水平。1例首次注射IVBr后发生IOI的患者视力恶化，因此停用IVBr，并将该患者改用玻璃体内注射阿柏西普联合球后注射曲安奈德。另外2例发生IOI的患者继续使用IVBr。所有有或无IOI的患者在注射IVBr后VEGF均下降。另一方面，在1个月时，3例发生IOI的患者的IL-6、IL-8、MCP-1、IP-10和Flt-3L水平高于基线水平，也高于3例未发生IOI的患者。在2例发生IOI的患者中，尽管继续使用IVBr，但从注射IVBr后1个月到2个月，不仅flare减少，而且IL-8、IP-10和Flt-3L也减少。该病例系列可能有助于更好地理解IVBr后IOI的发病机制。
