Abstract
Purpose :
Since the approval of brolucizumab, a number of post-marketing cases of severe visual acuity loss resulting from severe intraocular inflammation (IOI) and retinal vasculitis and/or retinal artery occlusion have been reported after intravitreal injection (IVI) ofbrolucizumab. To investigate the efficacy of sub-Tenon’s capsule triamcinolone acetonide (STTA) injections for preventing development of IOI related to brolucizumab IVI for neovascular age-related macular degeneration (nAMD).
Methods :
Consecutive patients with nAMD treated with brolucizumab IVIs were studied retrospectively. All eyes treated with brolucizumab in the clinic were switched from another anti-vascular endothelial growth factor agent. After the fourth case of IOI related to brolucizumab IVI, all eyes treated with brolucizumab received a STTA injection. The patients were divided into two groups: brolucizumab alone and brolucizumab combined with a STTA injection.
Results :
Thirty-three eyes (33 patients) treated with at least one brolucizumab IVI were studied: 14 eyes received brolucizumab IVI alone and 19 eyes received the combination therapy. IOI related to brolucizumab IVIs developed in four (28.6%) of 14 eyes in the brolucizumab group; IOI was severe in one eye, moderate in two eyes, and mild in one eye according to the HAWK and HARRIER trial definition; IOI did not develop in the 19 eyes that received combination therapy, the difference of which reached significance (p=0.025). Regarding combination therapy, intraocular pressure in one (5.3%) eye increased to 22 to about 24 mmHg after the STTA injection and returned to normal range within 2 months without medication; no cataracts developed during this short mean follow-up period follow-up period of 7.8 ± 0.7 months.
Conclusions :
The results indicated the possible preventative effect of a STTA injection on development of brolucizumab-associated IOI. The combination therapy of a brolucizumab IVI with a STTA injection may be recommended for patients with apoor or no response to other anti-VEGF agentsor for those who require frequent IVIs of anti-VEGF agents, especially in the dominant eye.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.