RESUMEN
BACKGROUND: This study evaluated the safety and effectiveness of combining intravitreal brolucizumab injection with sub-tenon's capsule triamcinolone acetonide injection (STTA) during the loading phase for polypoidal choroidal vasculopathy (PCV). METHODS: In this retrospective observational study, untreated patients with PCV receiving intravitreal brolucizumab injections with STTA during loading at Saitama Medical University Hospital's Eye Center from May 2021 to June 2022 were analyzed. Complete regression rates of polypoidal lesions were assessed using indocyanine green angiography 12 weeks post-treatment initiation. RESULTS: Nineteen patients (19 eyes) participated. Best-corrected visual acuity significantly improved at eight weeks compared to baseline. No significant intraocular pressure increases occurred throughout the loading phase, while central foveal and choroidal thickness significantly reduced at 4, 8, and 12 weeks. Subretinal fluid was present in all patients before treatment, rapidly resolving post-intravitreal brolucizumab injections and STTA, with residual rates of 36.8% (seven eyes) and 5.3% (one eye) at four and 12 weeks, respectively. Intraocular inflammation did not occur during the loading phase, and the complete regression rate of polypoidal lesions was 89.5% (17 eyes). CONCLUSIONS: Combining intravitreal brolucizumab injection with STTA during the loading phase may be one treatment option for PCV management.
RESUMEN
We aimed to investigate whether a treat-and-extend regimen of intravitreal brolucizumab (6.0 mg/0.05 mL) is effective for eyes with exudative age-related macular degeneration (AMD) refractory to aflibercept for 12 months. Sixty eyes from 56 patients receiving brolucizumab for exudative AMD refractory to aflibercept were included. Patients received a mean of 30.1 aflibercept administrations for a mean 67.9-month follow-up. All patients exhibited exudation on optical coherence tomography (OCT) despite regular 4-8 weeks of aflibercept administration. Visit 1 was scheduled at the same interval from the last aflibercept injection to the baseline. The treatment interval was extended or shortened by 1-2 weeks depending on the presence or absence of exudation on OCT. After switching to brolucizumab, the follow-up interval significantly extended at 12 months (before switching: 7.6 ± 3.8 weeks vs. at 12 months: 12.1 ± 6.2 weeks, p = 1.3 × 10-7). Forty-three percent of the eyes achieved a dry macula at 12 months after switching. However, the best-corrected visual acuity did not improve at any visit. Morphologically, the central retinal thickness and subfoveal choroidal thickness significantly decreased from baseline at 12 months (p = 3.6 × 10-3 and 1.0 × 10-3, respectively). Switching to brolucizumab can be considered to extend the treatment interval in eyes with exudative AMD refractory to aflibercept.
RESUMEN
This report describes a case of choroidal effusion after intravitreal brolucizumab injection for wet age-related macular degeneration (AMD). A 71-year-old Korean man with a history of wet AMD visited our clinic. On examination, the best-corrected distance visual acuity (BCVA) was 20/200 in the right eye. Fundus photography and optical coherence tomography showed wet AMD in the right eye. The patient showed no improvement while undergoing treatment with anti-vascular endothelial growth factor therapy (aflibercept, 6 times; ranibizumab, 5 times; and bevacizumab 3 times). We administered intravitreal brolucizumab injections in the right eye of the patient. After first brolucizumab injection, the BCVA improved from 20/200 to 20/63 in the right eye. Two months after the intravitreal brolucizumab injection, recurrence of wet AMD and deterioration of the BCVA to 20/200 was observed on the right eye. The patient underwent a second intravitreal brolucizumab injection in the right eye in the same manner. Three days after the second brolucizumab injection, choroidal effusion was observed in the right eye. The choroidal effusion resolved completely 12 days after the injection, without any additional treatment. Intravitreal brolucizumab injection may provoke choroidal effusion. Although it may resolve promptly, short-term follow-up fundus examinations may be necessary for the early diagnosis and treatment of this complication.