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Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab.
Baumal, Caroline R; Spaide, Richard F; Vajzovic, Lejla; Freund, K Bailey; Walter, Scott D; John, Vishak; Rich, Ryan; Chaudhry, Nauman; Lakhanpal, Rohit R; Oellers, Patrick R; Leveque, Thellea K; Rutledge, Bryan K; Chittum, Mark; Bacci, Tommaso; Enriquez, Ana Bety; Sund, Newman J; Subong, Eric N P; Albini, Thomas A.
Afiliação
  • Baumal CR; Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts. Electronic address: cbaumal@tuftsmedicalcenter.org.
  • Spaide RF; Vitreous, Retina, Macula Consultants of New York, New York, New York.
  • Vajzovic L; Duke University Eye Center, Durham, North Carolina.
  • Freund KB; Vitreous, Retina, Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University, New York, New York.
  • Walter SD; University of Connecticut, Farmington, Connecticut.
  • John V; Vistar Eye Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
  • Rich R; Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado.
  • Chaudhry N; Department of Ophthalmology, Yale University School of Medicine, New Have, Connecticut.
  • Lakhanpal RR; The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey.
  • Oellers PR; Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York.
  • Leveque TK; Department of Ophthalmology, University of Washington, Seattle, Washington.
  • Rutledge BK; Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York.
  • Chittum M; Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado.
  • Bacci T; Vitreous, Retina, Macula Consultants of New York, New York, New York.
  • Enriquez AB; Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
  • Sund NJ; The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey.
  • Subong ENP; The Retina Group of Seattle, Seattle, Washington.
  • Albini TA; Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Ophthalmology ; 127(10): 1345-1359, 2020 10.
Article em En | MEDLINE | ID: mdl-32344075
ABSTRACT

PURPOSE:

To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration.

DESIGN:

Retrospective case series.

PARTICIPANTS:

Fifteen eyes from 12 patients identified from 10 United States centers.

METHODS:

Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME

MEASURES:

Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies.

RESULTS:

The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033).

CONCLUSIONS:

Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Uveíte / Acuidade Visual / Vasculite Retiniana / Anticorpos Monoclonais Humanizados Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Ophthalmology Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Uveíte / Acuidade Visual / Vasculite Retiniana / Anticorpos Monoclonais Humanizados Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Ophthalmology Ano de publicação: 2020 Tipo de documento: Article