Severe Intraocular Inflammation Following Intravitreal Faricimab.

Importance: Monitoring for and reporting potential cases of intraocular inflammation (IOI) in clinical practice despite limited occurrences in clinical trials, including experiences with relatively new intravitreal agents, such as brolucizumab, pegcetacoplan, or faricimab, helps balance potential benefits and risks of these agents. Objective: To provide descriptions of 3 initially culture-negative cases of acute, severe, posterior-segment IOI events occurring within the same month following intravitreal faricimab injections at a single institution. Design, Setting, and Participants: In this case series, 3 patients manifesting acute, severe IOI following intravitreal injection of faricimab were identified between September 20, 2023, and October 20, 2023. Exposure: Faricimab, 6 mg (0.05 mL of 120 mg/mL solution), for neovascular age-related macular degeneration among patients previously treated with aflibercept; 1 patient also had prior exposure to bevacizumab. Main Outcomes and Measures: Visual acuity, vitreous taps for bacterial or fungal cultures, and retinal imaging. Results: All 3 patients received intravitreal faricimab injections between September 20 and October 20, 2023, from 2 different lot numbers (expiration dates, July 2025) at 3 locations of 1 institution among 3 of 19 retina physicians. Visual acuities with correction were 20/63 OS for patient 1, 20/40 OD for patient 2, and 20/20 OS for patient 3 prior to injection. All 3 patients developed acute, severe inflammation involving the anterior and posterior segment within 3 to 4 days after injection, with visual acuities of hand motion OS, counting fingers OD, and hand motion OS, respectively. Two patients were continuing faricimab treatment while 1 patient was initiating faricimab treatment. All received intravitreal ceftazidime, 2.2 mg/0.1 mL, and vancomycin, 1 mg/0.1 mL, immediately following vitreous taps. All vitreous tap culture results were negative. One patient underwent vitrectomy 1 day following presentation. Intraoperative vitreous culture grew 1 colony of Staphylococcus epidermidis, judged a likely contaminant by infectious disease specialists. All symptoms resolved within 1 month; visual acuities with correction were 20/100 OS for patient 1, 20/50 OD for patient 2, and 20/30 OS for patient 3. Conclusions and Relevance: In this case series, 3 patients with acute, severe IOI within 1 month at 3 different locations among 3 ophthalmologists of 1 institution following intravitreal faricimab could represent some unknown storage or handling problem. However, this cluster suggests such inflammatory events may be more common than anticipated from faricimab trial reports, emphasizing the continued need for vigilance to detect and report such cases following regulatory approval.

[Bilateral effusion syndrome induced by chlorthalidon]. / Chlortalidon als Ursache eines bilateralen Effusionssyndroms.

Uveal effusion can lead to anterior swelling of the choroid up to angle-closure glaucoma. This article reports the case of a 57-year-old male patient who presented with headache, vertigo and bilaterally reduced visual acuity. The examination showed a myopic shift and angle-closure glaucoma caused by uveal effusion. The medical history revealed that 3 days before the appearance of the symptoms, treatment with chlorthalidone was added to the antihypertensive medication. After discontinuation of the chlorthalidone intake the uveal effusion and its concomitant symptoms disappeared without residues.

Uveal effusion syndrome in 104 eyes: Response to corticosteroids - The 2017 Axel C. Hansen lecture.

PURPOSE: The purpose of the study was to investigate the corticosteroids for uveal effusion syndrome (UES). METHODS: Retrospective series of 104 eyes with UES treated with oral corticosteroids (OCS), periocular corticosteroids (PCS), topical corticosteroids (TCS), or observation (OBS). Main outcome measure was UES resolution. RESULTS: Of 104 eyes, treatment included OCS (n = 27), PCS (n = 12), TCS (n = 11), and OBS (n = 54). A comparison of the four groups (OCS vs. PCS vs. TCS vs. OBS) revealed differences in those managed with OCS versus OBS as younger (66 vs. 72 years, P = 0.049), PCS versus OBS as male (100% vs. 54%, P = 0.002), PCS versus OBS with decreased visual acuity (VA)/visual field (91% vs. 51%, P = 0.018), and OBS versus OCS as asymptomatic (28% vs. 0%, P = 0.001). Of the 59 with follow-up information, management included OCS (n = 21), PCS (n = 12), TCS (n = 6), and OBS (n = 20). There were differences in initial VA <20/400 in PCS versus OBS (42% vs. 5%, P = 0.018), effusion thickness in TCS versus OCS (7 vs. 3 mm, P = 0.004), and serous retinal detachment in PCS versus OBS (100% vs. 30%, P < 0.001) and PCS versus OCS (100% vs. 57%, P = 0.012). Regarding outcomes, VA showed less worsening in OCS versus OBS (0% vs. 30%, P = 0.008) and OCS versus PCS (0% vs. 33%, P = 0.012). There was no difference in rate of effusion resolution or effusion recurrence. Overall, using combination of corticosteroid therapies, effusion resolution was achieved in 56/59 (95%) cases and the need for surgical management with scleral windows was necessary in only 3/59 (5%) cases. Complications included cataract (n = 9) and no instance of steroid-induced glaucoma. CONCLUSION: Management of UES is complex and depends on disease severity. Using various corticosteroid delivery routes, UES control was achieved in 95%, and scleral window surgery was required in only 5%. A trial of corticosteroids can benefit patients with UES.

Intravitreal aflibercept for choroidal neovascularization in ocular sarcoidosis.

PURPOSE: To report a case of choroidal neovascularization (CNV) in a patient with ocular sarcoidosis treated by intravitreal aflibercept. METHODS: A 27-year old man was referred to our department because of sudden visual acuity decrease (best-corrected visual acuity (BCVA) was 20/80 LE). Fundus examination showed bilateral optic disk swelling, retinal pigment epithelium changes at the posterior pole, yellowish chorioretinal lesions in the periphery, and the presence of a prominent peripapillary neovascular complex. RESULTS: The clinical diagnosis was most compatible with ocular sarcoidosis, later confirmed by mediastinal lymph node biopsy. Fluorescein and indocyanine green angiography confirmed the presence of active peripapillary type 2 (classic) CNV in both eyes. Given that the exudation of the peripapillary CNV harmed the fovea, the patient underwent a single intravitreal aflibercept injection LE. One month after the treatment, LE BCVA decreased to 20/125. Spectral-domain optical coherence tomography (SD-OCT) showed complete resolution of subretinal fluid but revealed outer retinal atrophy with complete loss of the ellipsoid zone (EZ) in the macula (possibly responsible for visual acuity worsening). Six months later, LE BCVA slightly increased to 20/100, and SD-OCT showed partial recovery of the EZ in the macula. No adverse events related to the treatment were recorded during follow-up. CONCLUSIONS: We report a case of CNV in a patient with ocular sarcoidosis treated with intravitreal aflibercept. In our experience, intravitreal aflibercept injection achieved morphologic resolution for sarcoid-related peripapillary CNV.

[Uveal effusion induced by escitalopram]. / Efusión uveal inducido por escitalopram.

CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

Uveal effusion as a mechanism of bilateral angle-closure glaucoma induced by chlorthalidone.

PURPOSE: To report a novel case of acute bilateral uveal effusions, angle closure, and acute myopia induced by administration of chlorthalidone. METHODS: Case report. RESULTS: Bilateral shallow anterior chambers, high intraocular pressure, and a myopic shift were encountered in a patient 1 week after initiation of chlorthalidone. Ultrasound evaluation revealed bilateral ciliochoroidal effusions, appositional angle closure, and suspected ciliary body edema. Cessation of chlorthalidone, in addition to administration of cycloplegics and ocular antihypertensives, resulted in prompt resolution of this idiosyncratic reaction. CONCLUSIONS: The antihypertensive medication chlorthalidone may cause bilateral uveal effusions inducing acute angle-closure glaucoma and acute myopia.

Unilateral choroidal granulomas complicated by choroidal neovascular membrane treated successfully with intravitreal triamcinolone in a patient with sarcoidosis.

This case describes the use of intravitreal triamcinolone in the treatment of unilateral choroidal granulomas secondary to systemic sarcoidosis complicated by choroidal neovascular membrane. A single injection of 2 mg intravitreal triamcinolone was administered as treatment for rapidly progressing choroidal granulomas and associated choroidal neovascular membrane with subretinal fluid. Visual acuity had dropped from 6/5 to 6/48 with the progressing lesions. The patient was a 52-year-old woman with type 2 diabetes mellitus who was reluctant to consider oral steroids in view of their side effect profile. Ten days after injection, visual acuity improved to 6/24 and to 6/6 at 3 months follow-up with resolution of the subretinal fluid. There was no rise in intraocular pressure. There has been no recurrence at 5 months follow-up.

Medical therapy for uveal effusion syndrome.

PURPOSE: To report a case series of three patients with bilateral uveal effusion syndrome (UES), treated conservatively with oral carbonic anhydrase inhibitors and topical prostaglandin analogues (PAs). METHODS: Three patients with bilateral UES were treated with the same initial therapy. Topical PA latanoprost 0.005% and acetazolamide 250 mg were administered in order to reduce intraocular pressure, improve uveoscleral outflow, and facilitate resolution of uveal effusion. RESULTS: The chorioretinal detachment resolved within 3 months in two reported patients while the third one underwent surgery on his left eye. After clinical improvement, further oral therapy with acetazolamide was stopped, while topical prostaglandins were continued for at least the next 3 months. All patients were free from recurrence during the follow-up period. CONCLUSION: Although the usually recommended UES therapy is partial or full-thickness sclerectomy, our case series showed apparent resolution of chorioretinal detachment in two patients on medical therapy alone. Conservative therapy may be the first step before the standard recommended surgical approach, but further studies are needed to verify the effectiveness of reported therapy.

Severe HLA B27-associated uveitis complicated by hypotony, serous retinal detachment, and ciliochoroidal effusion.

PURPOSE: To report on severe HLA B27-associated anterior uveitis complicated by vitritis, hypotony, and serous retinal detachment. METHODS: Retrospective case series. RESULTS: Five patients with HLA B27-associated uveitis presented with an acute anterior uveitis complicated by vitritis, hypotony, serous retinal detachment, and ciliochoroidal effusion. Two patients had previously acute anterior uveitis and two suffered from HLA B27-associated systemic disease. Laboratory and imaging examinations did not reveal another cause of uveitis. Despite the aggressive treatment a prolonged and slow recovery followed. Four patients developed macular edema and one additional patient developed a macular pucker. Finally, 3 eyes improved, 2 eyes developed atrophy, and 1 was lost at 4-month follow-up with visual acuity of hand movements. CONCLUSIONS: The authors conclude that severe uveitis with a serous retinal detachment might develop in HLA B27-positive patients and may be complicated by protracted hypotony, macular edema, and poor visual outcome.

Inferior peripheral nonperfusion in bilateral diffuse uveal melanocytic proliferation.

Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a paraneoplastic syndrome characterized by cataract, photoreceptor loss and subretinal fluid overlying patchy areas of retinal pigment epithelium atrophy, and a diffusely thickened choroid with focal nodules. We present the case of a 64-year-old woman with a history of endometrial adenocarcinoma who developed BDUMP with bilateral exudative retinal detachments with inferior peripheral retinal ischemia. This new finding of peripheral nonperfusion expands the spectrum of BDUMP.