Abstract
Purpose :
Following its approval by the Food and Drug Administration (FDA) for the treatment of exudative age-related macular degeneration (AMD), brolucizumab has been associated with post-injection intraocular inflammation (IOI) and retinal vasculitis in select cases. We aimed to evaluate clinical outcomes and adverse events (AE) following intravitreal brolucizumab administration at a university-based practice.
Methods :
The clinical records of all eyes that received intravitreal brolucizumab at Bascom Palmer Eye Institute between December 1, 2019, and April 1, 2021, were reviewed.
Results :
345 eyes of 278 patients received 801 brolucizumab injections, resulting in 20 eyes of 17 patients who developed an AE. The mean visual acuity (VA) of the entire cohort before brolucizumab injection was 20/51. In patients who developed an AE, baseline VA was 20/43, while VA at initial presentation of the AE was 20/76, representing a loss of approximately 3 lines. Of eyes experiencing an AE, the mean number of injections was 2.3, and the interval between the last brolucizumab injection and presentation with the AE was 24.2 days. The most common presenting symptoms in eyes experiencing an AE were blurry vision (60%) and floaters (50%). Intraocular inflammation was the most common AE (75% of all AEs). Of those eyes with inflammation, 29% had iritis, 50% had vitritis, and 21% had both. No eyes were noted to develop retinitis or choroiditis. Ten percent of eyes with IOI also developed epiretinal membrane. Additionally, there were cases of conjunctivitis (5%), venous occlusion (5%), optic neuropathy (5%), and RPE tear (5%). There was no case of retinal vasculitis. In eyes with IOI, treatment included topical steroids (45%), topical and oral steroids (25%), and observation (30%). Of eyes experiencing IOI, the mean VA at last follow-up was 20/59, representing a loss of 1.5 lines. All eyes with IOI had resolution of inflammation by last follow-up examination.
Conclusions :
An adverse event was observed in 5.8% of eyes treated with brolucizumab in this university-based practice. The average symptom onset was 24 days after the last injection. Most symptoms resolved after treatment but mean VA in this cohort decreased on average approximately 1.5 Snellen lines from baseline.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.