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Hirayama K, Yamamoto M, Honda S, Kyo A, Misawa N, Kohno T. Switching to Intravitreal Brolucizumab after Ranibizumab or Aflibercept Using Treat and Extend Regimen for Neovascular Age-Related Macular Degeneration in Japanese Patients: 1-Year Results and Factors Associated with Treatment Responsiveness. J Clin Med 2024; 13:4375. [PMID: 39124642 PMCID: PMC11312903 DOI: 10.3390/jcm13154375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Objective: To purpose of this study was to retrospectively evaluate the 1-year outcomes and factors associated with the treatment responsiveness of switching to intravitreal brolucizumab (IVBR) for neovascular age-related macular degeneration (nAMD) in Japanese patients refractory to ranibizumab or aflibercept using a treat and extend (TAE) regimen. Methods: A total of 48 eyes of 47 nAMD patients were switched to IVBR, and 36 eyes of 35 patients (27 males and 8 females) underwent 1-year treatment after the switch. Results: The rate of dry macula was significantly higher 12 months after the switch to IVBR (p < 0.001), with a significant decrease in the mean central macular thickness (CMT) and the mean central choroidal thickness (CCT) (p < 0.01 and p < 0.01, respectively). The injection interval was significantly extended from 7.0 ± 1.7 weeks to 10.3 ± 2.5 weeks 12 months after the switch (p < 0.001). In the multivariate analysis, a smaller number of prior anti-VEGF injections (p = 0.025; odds ratio: 0.947; 95% confidence interval: 0.903-0.994) and a pre-switching CCT of less than 250 µm (p = 0.023; odds ratio: 0.099; 95% confidence interval: 0.013-0.731) were associated with the good response group. Conclusions: These results suggest that IVBR may suppress disease activity and prolong the injection interval by switching for AMD patients with an insufficient response to treatment with ranibizumab and aflibercept.
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Affiliation(s)
| | - Manabu Yamamoto
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka 5450021, Japan; (K.H.); (A.K.); (N.M.); (T.K.)
| | - Shigeru Honda
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka 5450021, Japan; (K.H.); (A.K.); (N.M.); (T.K.)
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2
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Yoshikawa Y, Sakaki Y, Shinoda K, Kataoka K. Safety and Effectiveness of Intravitreal Brolucizumab Injection in Combination With Sub-Tenon's Capsule Triamcinolone Acetonide Injection for Polypoidal Choroidal Vasculopathy During the Loading Phase. Cureus 2024; 16:e59481. [PMID: 38832144 PMCID: PMC11145932 DOI: 10.7759/cureus.59481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/05/2024] Open
Abstract
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.
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Affiliation(s)
| | - Yu Sakaki
- Ophthalmology, Kozawa Eye Hospital and Diabetes Center, Ibaraki, JPN
| | - Kei Shinoda
- Opthalmology, Saitama Medical University, Saitama, JPN
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3
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Hashimoto Y, Inoda S, Takahashi H, Takahashi R, Yoshida H, Fujino Y, Sakamoto S, Kawashima H, Yanagi Y. Factors Associated With Intraocular Inflammation in Neovascular Age-Related Macular Degeneration Patients Treated With Brolucizumab. Invest Ophthalmol Vis Sci 2024; 65:8. [PMID: 38170536 PMCID: PMC10768698 DOI: 10.1167/iovs.65.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose To identify factors associated with intraocular inflammation (IOI) in patients with neovascular age-related macular degeneration (nAMD) treated with brolucizumab. Methods In this prospective observational study, we collected aqueous humor samples from 96 eyes of 96 patients receiving treatment with brolucizumab; IOI subsequently developed in 19 eyes of 19 patients. To identify cytokines upregulated in eyes with subsequent development of IOI, we compared the aqueous humor cytokine levels between the IOI and non-IOI groups. We also collected plasma from 20 patients who developed IOI and 20 age- and sex-matched controls to identify differences in plasma biomarkers and the subfraction of CD4+ cells. Using stepwise variable selection and multivariate binary regression analysis, we developed an algorithm that accurately assessed the likelihood of IOI occurrence. Results The IOI group showed elevated aqueous humor levels of P-selectin (584 vs. 324 pg/mL, P = 0.013), TNF-α (0.89 vs. 0.60 pg/mL, P = 0.018), and IL-1α (2.0 vs. 1.4 pg/mL, P = 0.035) compared with the non-IOI group. Serum MMP-9 concentrations were higher in the IOI group than the non-IOI group (18,310 vs. 13,450 pg/mL, P = 0.029). Furthermore, the percentage of Th2 cells was significantly decreased in the IOI compared with the non-IOI group (3.1% vs. 4.2%, P = 0.013). The receiver operating characteristic curves for the optimal models showed an area under the curve ranging from 0.71 to 0.89, indicating good performance. Conclusions The combination of elevated concentrations of multiple aqueous humor cytokines and of serum MMP-9 and a lower number of plasma Th2 cells is associated with brolucizumab-related IOI in patients with nAMD.
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Affiliation(s)
- Yuto Hashimoto
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
- Department of Ophthalmology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Ryota Takahashi
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Hana Yoshida
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Shinichi Sakamoto
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | | | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University Medical Center, Yokohama, Japan
- The Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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4
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Bodaghi B, Khanani AM, Khoramnia R, Pavesio C, Nguyen QD. Gains in the current understanding of managing neovascular AMD with brolucizumab. J Ophthalmic Inflamm Infect 2023; 13:51. [PMID: 37995057 PMCID: PMC10667168 DOI: 10.1186/s12348-023-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/11/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Unresolved retinal fluid and high injection burden are major challenges for patients with neovascular age-related macular degeneration. Brolucizumab addresses these challenges by providing robust vision gains and superior fluid resolution, with the potential for longer treatment intervals. Brolucizumab has been associated with adverse events of retinal vasculitis and retinal vascular occlusion typically in the presence of intraocular inflammation (IOI). To define the incidence of the adverse events, Novartis convened an external safety review committee, which found a rate of 4.6% for definite or probable IOI, 3.3% for retinal vasculitis, and 2.1% for retinal vascular occlusion in the HAWK and HARRIER trials. Novartis also established a coalition to explore 4 areas regarding the adverse events: root cause, patient characterization, event mitigation and vigilance, and treatment protocols for the adverse events. Based on the coalition findings, a risk mitigation framework was developed. Prior to initiating treatment with brolucizumab, it is important to weigh the potential benefit against risk of adverse events and to consider patient risk factors such as prior history of IOI and/or retinal vascular occlusion. To mitigate the potential for IOI-related adverse events, it is important to conduct a thorough dilated eye examination before each injection and closely monitor patients throughout treatment. Patients should be educated on symptoms of IOI to monitor for. Brolucizumab should not be injected in the presence of active IOI. If an adverse event is identified, prompt and intensive treatment should be considered. CONCLUSION Progress has been made in understanding how to mitigate IOI-related adverse events following treatment with brolucizumab.
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Affiliation(s)
- Bahram Bodaghi
- Department of Ophthalmology & Visual Sciences, Sorbonne University, Paris, France
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Ramin Khoramnia
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital and University College London, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.
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5
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Garweg JG, Keiper J, Pfister IB, Schild C. Functional Outcomes of Brolucizumab-Induced Intraocular Inflammation Involving the Posterior Segment-A Meta-Analysis and Systematic Review. J Clin Med 2023; 12:4671. [PMID: 37510788 PMCID: PMC10380786 DOI: 10.3390/jcm12144671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Early poor outcomes of intraocular inflammation (IOI) after intravitreal brolucizumab (IVB) have negatively affected the use of brolucizumab in clinical routine. We wished to identify factors related to the treatment details of IOI involving the posterior segment resulting from IVB for neovascular AMD (nAMD), if these were reported in detail. Articles were retrieved from PubMed, Scopus, ClinicalTrials, and CENTRAL using the following search terms: <Brolucizumab> AND <AMD> AND <intraocular inflammation>. The risk of bias was rated using the JBI Critical Appraisal Tool. We included 31 reports (41 patients and 46 eyes). Patients were 75.9 ± 8.5 years, and 58.5% were female. IOI occurred 41.7 ± 37.5 (median 37.0) days after treatment initiation with 2.0 ± 1.3 (1-6) IVB injections. A mean change in visual acuity of -14.6 ± 21.0 (median -6.5) letters was reported. The mean time from first IOI signs to the initiation of any anti-inflammatory treatment was 3.3 ± 6.2 days, with 63% of the patients receiving systemic corticosteroids as standard treatment. Finally, a period effect was observed, with a change in visual acuity of -25.3 ± 27.1 and -2.6 ± 7.3 letters in the chronologically first and last third, respectively, of treated eyes (effect size: r = 0.71; p = 0.006). Functional outcomes markedly improved with increasing experience in managing IOI.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
- Department of Ophthalmology, Inselspital (Bern University Hospital), University of Bern, 3010 Bern, Switzerland
| | - Judith Keiper
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
- Department of Ophthalmology, Inselspital (Bern University Hospital), University of Bern, 3010 Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
| | - Christin Schild
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
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Wykoff CC, Matsumoto H, Barakat MR, Karcher H, Lozama A, Mayhook A, Oshagbemi OA, Zorina O, Hassan TS, Khanani AM, Heier JS. RETINAL VASCULITIS OR VASCULAR OCCLUSION AFTER BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Systematic Review of Real-World Evidence. Retina 2023; 43:1051-1063. [PMID: 36893438 PMCID: PMC10278563 DOI: 10.1097/iae.0000000000003769] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/07/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Retinal vasculitis or vascular occlusion (RV/RO) have been reported after brolucizumab for neovascular age-related macular degeneration. This systematic literature review evaluated RV/RO events after brolucizumab in real-world practice. METHODS Systematic literature searches identified 89 publications; 19 were included. RESULTS Publications described 63 patients (70 eyes) with an RV/RO event following brolucizumab. Mean age was 77.6 years and 77.8% of patients were women; 32 eyes (45.7%) received one brolucizumab injection before RV/RO. Mean (range) time to event from last brolucizumab injection was 19.4 (0-63) days, with 87.5% of events occurring within 30 days. Among eyes with preevent and postevent visual acuity (VA) assessments, 22/42 eyes (52.4%) showed unchanged (±0.08 logMAR) or improved vision from last recorded preevent assessment at latest follow-up, whereas 15/42 eyes (35.7%) showed ≥0.30 logMAR (≥15 letters) VA reduction. Patients with no VA loss were on average slightly younger and had a higher proportion of nonocclusive events. CONCLUSION Most RV/RO events reported after brolucizumab in early real-world practice occurred in women. Among eyes with VA measurements, approximately half experienced VA loss; overall, about one-third had VA reduction of ≥0.30 logMAR at latest follow-up, with indications of regional variations.
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Affiliation(s)
- Charles C. Wykoff
- Retina Consultants of Texas, Houston and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mark R. Barakat
- Retinal Consultants of Arizona, Phoenix and University of Arizona College of Medicine, Phoenix, Arizona
| | | | - Anthony Lozama
- Novartis Pharmaceuticals Corporation, Minneapolis, Minnesota
| | | | | | | | - Tarek S. Hassan
- Associated Retinal Consultants P.C., Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Arshad M. Khanani
- Sierra Eye Associates, Reno and University of Nevada, Reno School of Medicine, Reno, Nevada
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Fukuda Y, Sakurada Y, Matsubara M, Kotoda Y, Kasai Y, Sugiyama A, Kashiwagi K. Comparison of one-year outcomes between as-needed brolucizumab and aflibercept for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2023:10.1007/s10384-023-00999-4. [PMID: 37289296 DOI: 10.1007/s10384-023-00999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To compare the one-year visual and anatomic outcomes of an as-needed regimen of brolucizumab and aflibercept for polypoidal choroidal vasculopathy (PCV). STUDY DESIGN A retrospective comparative study. METHODS A retrospective medical chart review was performed for consecutive 56 eyes from 56 patients with PCV initially treated with thee monthly intravitreal aflibercept (n = 33, 2.0 mg/0.05 ml) or brolucizumab (n = 23, 6.0 mg/0.05 ml) followed by as-needed administration, followed up for at least 12 months. All patients were followed up monthly, and fluorescein and indocyanine green angiography (ICGA) were performed at baseline, 3-month, and 12-month visits. RESULTS At the 12-month visit, best-corrected visual acuity significantly improved from 0.30 ± 0.31 to 0.21 ± 0.29 (p = 0.042) in the brolucizumab-treated group and from 0.24 ± 0.25 to 0.14 ± 0.25 (p = 7.7×10-3) in the aflibercept-treated group, suggesting comparable visual improvement in both groups. Central retinal thickness and subfoveal choroidal thickness decreased by 38.4% and 14.2%, respectively, in the brolucizumab-treated group and by 34.8% and 13.9%, respectively, in the aflibercept-treated group at the 12-month visit. The mean number of additional injections was significantly higher in the aflibercept-treated group (2.9 ± 2.7) than in the brolucizumab-treated group (1.3 ± 1.2, p = 0.045). The complete resolution of polypoidal lesions on ICGA was higher in the brolucizumab-treated group than in the aflibercept-treated group (3-month visit: 56.5% vs 30.3%, 12-month visit: 56.5% vs 30.3%). CONCLUSIONS In treatment-naïve eyes with PCV, the as-needed administration regimen of brolucizumab was comparable to aflibercept in terms of visual and anatomical outcomes, with fewer additional injections during the 12-month follow-up.
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Affiliation(s)
- Yoshiko Fukuda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan.
| | - Mio Matsubara
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
| | - Yumi Kotoda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
| | - Yuka Kasai
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
| | - Atsushi Sugiyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3821, Japan
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Kikushima W, Sakurada Y, Fukuda Y, Matsubara M, Kotoda Y, Sugiyama A, Kashiwagi K. A Treat-and-Extend Regimen of Intravitreal Brolucizumab for Exudative Age-Related Macular Degeneration Refractory to Aflibercept: A 12-Month Result. Pharmaceuticals (Basel) 2023; 16:ph16040562. [PMID: 37111318 PMCID: PMC10141467 DOI: 10.3390/ph16040562] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
- Wataru Kikushima
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoshiko Fukuda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Mio Matsubara
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yumi Kotoda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Atsushi Sugiyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
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Somisetty S, Santina A, Sarraf D, Mieler WF. The Impact of Systemic Medications on Retinal Function. Asia Pac J Ophthalmol (Phila) 2023; 12:115-157. [PMID: 36971705 DOI: 10.1097/apo.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.
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Affiliation(s)
- Swathi Somisetty
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - Ahmad Santina
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - David Sarraf
- Jules Stein Eye Institute, University of California, Los Angeles, CA
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Hirano T, Toriyama Y, Takahashi Y, Hoshiyama K, Murata T. Retinal arterial occlusive vasculitis after multiple intravitreal brolucizumab injections for diabetic macular edema. Am J Ophthalmol Case Rep 2022; 29:101788. [PMID: 36632338 PMCID: PMC9826871 DOI: 10.1016/j.ajoc.2022.101788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To describe a case of unilateral retinal arterial occlusive vasculitis after multiple intravitreal brolucizumab (IVBr) treatments for diabetic macular edema (DME). Observations A 68-year-old Japanese woman who had a 3-year history of insulin-dependent diabetes mellitus presented with decreased vision in the right eye (oculus dexter, OD). After two consecutive IVBr (3 mg) treatments for DME, spaced 6 weeks apart, her best corrected visual acuity improved from 20/32 to 20/28 OD, as central macular thickness (CMT) decreased from 368 μm to 253 μm on optical coherence tomography (OCT). Immediately after the 3rd IVBr, the right intraocular pressure (IOP) increased. One week later, iritis (aqueous flares: 65.0 photon count [PC]/ms) was observed, followed by localized vasculitis 2 weeks later. One month after the 3rd IVBr, extensive vasculitis and vasculitis occluding retinal arterioles were identified. Based on the history of IVBr use and clinical findings, intraocular inflammation (IOI) and subsequent retinal arterial occlusive vasculitis due to IVBr was diagnosed. Topical steroid administration (i.e., eye drops and subtenon injection) resulted in improvement of IOI after 3 months. She subsequently underwent two intravitreal aflibercept injections for DME and panretinal photocoagulation (PRP) to prevent the development of proliferative changes due to diabetic retinopathy. One year after the diagnosis of retinal arterial occlusive vasculitis, the patient had slight loss of vision (20/50) compared to baseline, due to the progression of cataracts, and OCT angiography (OCTA) showed extensive non-perfusion area on the temporal side. However, other examination findings (IOP: 16 mmHg, aqueous flares: 30.5 PC/ms, CMT: 283 μm) were stable. Conclusions and importance Diagnosis and treatment at a relatively early stage after the onset of IOI prevented severe visual impairment in this case. Topical betamethasone eye drops reduced anterior chamber inflammation associated with IVBr; however, vascular sheathing worsened when topical drops alone was used. Occlusive retinal vasculitis, diagnosed with fluorescein angiography (FA) and OCTA, appeared to stabilize when subtenon triamcinolone injection was added to topical steroid administration. Because the central macula was not involved, severe vision loss was prevented. It is unknown if topical steroid administration would be adequate to prevent worsening of occlusive vasculitis in other cases. Although not used in this case, oral prednisone is one treatment option that may prevent severe vision loss. However, it requires monitoring of side effects, such as elevated blood glucose levels. PRP is also an option in cases where progression of proliferative changes is a concern, as was done in this case. With these considerations in mind, it is important to diagnose brolucizumab-associated IOI and subsequent retinal arterial occlusive vasculitis in DME patients early and initiate treatment to prevent severe visual impairment. Diagnosing new IOI and subsequent retinal arterial occlusive vasculitis is more difficult in DME than in neovascular age-related macular degeneration because of the inflammatory component often associated vascular occlusions. Therefore, early IOI diagnosis and follow-up using various instruments such as laser flare cell meter, wide-field color imaging, OCT/OCTA, and FA, in addition to usual comprehensive ophthalmologic examinations, is crucial.
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11
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Holz FG, Iida T, Maruko I, Sadda SR. A CONSENSUS ON RISK MITIGATION FOR BROLUCIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Patient Selection, Evaluation, and Treatment. Retina 2022; 42:1629-1637. [PMID: 35994582 PMCID: PMC9387760 DOI: 10.1097/iae.0000000000003556] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Brolucizumab has high efficacy in retinal fluid resolution and provides the possibility for longer dosing intervals in the treatment of neovascular age-related macular degeneration. However, brolucizumab has been associated with events of retinal vasculitis and retinal vascular occlusion typically in the presence of other signs of intraocular inflammation (IOI). The purpose of this report is to provide guidance on the use of brolucizumab for neovascular age-related macular degeneration to a global audience. METHODS A literature review was conducted on adverse events related to IOI after administration of brolucizumab in eyes with neovascular age-related macular degeneration. RESULTS Possible risk factors for IOI and retinal vascular occlusion after brolucizumab should be considered before administering brolucizumab. Patients who receive brolucizumab should be educated on the symptoms, signs, and time course of IOI after brolucizumab. Before each injection of brolucizumab, physicians should assess the eye for any signs of inflammation and not treat with brolucizumab if inflammation is detected. Treatment of IOI should be prompt and provided with particular attention to the posterior segment. CONCLUSION Careful patient selection, patient education, assessment for inflammation, and intensive treatment of possible inflammation are important when using brolucizumab in patients with neovascular age-related macular degeneration.
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Affiliation(s)
- Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan; and
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan; and
| | - SriniVas R. Sadda
- Department of Ophthalmology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
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12
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Nguyen HV, Li AS, Silva AR, Leng T. Ocular adverse events following intravitreal brolucizumab for neovascular age-related macular degeneration at a single tertiary care center. Eur J Ophthalmol 2022; 32:2747-2751. [PMID: 34761684 PMCID: PMC10666666 DOI: 10.1177/11206721211059332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the incidence of ocular adverse effects (AEs) following brolucizumab injection for neovascular age-related macular degeneration at a tertiary academic institution. DESIGN Retrospective, single center cohort study. PARTICIPANTS All patients who received an intravitreal injection of brolucizumab 6 mg for neovascular age-related macular degeneration between October 7, 2019 and July 31, 2020. METHODS Medical records of all patients who received brolucizumab 6 mg during the aforementioned time period were carefully reviewed and all ocular adverse effects after injection were charted. MAIN OUTCOME MEASURES Incidence of post-injection ocular AEs, including intraocular inflammation (IOI), and time to development of AEs after injection. RESULTS A total of 77 patients received brolucizumab 6 mg for a total of 115 administrations during the study period. There were 4 AEs (3.5%), including three cases of IOI (2.6%), one central retinal artery occlusion, and one retinal detachment. Two men and two women were affected. CONCLUSION Ocular AEs, including those leading to severe vision loss, may develop after intravitreal brolucizumab 6 mg. A careful discussion of benefits and risks to brolucizumab should be conducted with all patients. PRECIS In this first case series of ocular adverse effects after brolucizumab 6 mg injection at a single tertiary care center, the incidence of ocular adverse effects was 3.5%, including a 2.6% incidence of intraocular inflammation.
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Affiliation(s)
- Huy V. Nguyen
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Angela S. Li
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amila R. Silva
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
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13
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Kusuhara S, Kim KW, Miki A, Nakamura M. Angiographic findings before and after the onset of brolucizumab-associated retinal vascular occlusion and intraocular inflammation. Am J Ophthalmol Case Rep 2022; 26:101521. [PMID: 35464682 PMCID: PMC9026644 DOI: 10.1016/j.ajoc.2022.101521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe angiographic features of a case of delayed-onset retinal vascular occlusion and intraocular inflammation (IOI) following brolucizumab intravitreal injection (IVI). Observations A 75-year-old woman with advanced age-related macular degeneration (AMD) complained of persistent distorted vision despite 1 aflibercept 2-mg IVI and subsequent 1 brolucizumab 6-mg IVI. At 20 days after brolucizumab IVI, clinical examination showed no signs of IOI, her right best-corrected visual acuity (BCVA) was 1.0 (Snellen equivalent, 20/20). Simultaneous fluorescein and indocyanine green angiography (FA/IA) performed 2 days later showed no abnormalities, but she noticed floaters and decreased vision in her right eye 5–6 hours after FA/IA. At 44 days after brolucizumab IVI, her right BCVA was 0.6 (Snellen equivalent, 20/33), and clinical examination revealed mutton-fat keratic precipitates, anterior chamber cells (2+), vitreous cells, vitreous haze (1+), and sheathed retinal vessels. FA showed filling defect and vascular staining/leakage at several retinal arteries and dye leakage from optic disc edge, where IA demonstrated dye staining as well. However, there was a retinal artery occlusion site which lacks angiographic signs indicative of active retinal vasculitis. The patient was diagnosed with retinal vascular occlusion and IOI which occurred approximately 3 weeks after brolucizumab IVI. Conclusions and importance Delayed brolucizumab-associated retinal vascular occlusion and IOI can develop from a condition in which no apparent abnormal findings exist on FA/IA. Together with the fact that angiographic signs observed in this case were not severe enough to induce retinal artery occlusion, potent and prolonged vascular endothelial growth factor inhibition by brolucizumab IVI might have caused severe damage to retinal vascular endothelial cells. Then, the damage subsequently led to retinal vascular occlusions and enhanced immune reaction to brolucizumab. The latter would be enhanced through the migration of immune cells towards vitreous cavity being allowed by disrupted inner blood retinal barrier.
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Affiliation(s)
- Sentaro Kusuhara
- Corresponding author. Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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14
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Tanaka K, Koizumi H, Tamashiro T, Itagaki K, Nakayama M, Maruko I, Wakugawa S, Terao N, Onoe H, Wakatsuki Y, Kasai A, Ogasawara M, Shintake H, Sugano Y, Yamamoto A, Kataoka K, Hasegawa T, Izumi T, Kawai M, Maruko R, Sekiryu T, Okada AA, Iida T, Mori R. Short-term results for brolucizumab in treatment-naïve neovascular age-related macular degeneration: a Japanese multicenter study. Jpn J Ophthalmol 2022; 66:379-385. [PMID: 35595951 DOI: 10.1007/s10384-022-00922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate short-term treatment outcomes of intravitreal brolucizumab (IVBr) for treatment-naïve neovascular age-related macular degeneration (AMD) in a Japanese multicenter study. STUDY DESIGN Retrospective case control study METHODS: The subjects were 58 eyes of 57 patients with neovascular AMD (43 men and 14 women, mean age 74.6 years) of whom 43 eyes of 42 patients completed initial loading of 3 monthly IVBr injections and were followed for more than 3 months. Best-corrected visual acuity (BCVA) changes, anatomical outcomes, and complications were investigated. RESULTS Of the 43 eyes that completed loading doses, the AMD subtype was type 1 and type 2 macular neovascularization (MNV) in 51%, polypoidal choroidal vasculopathy (PCV) in 42%, and type 3 MNV in 7%. At 3 months after initiating treatment, BCVA significantly improved (P = 0.002) and central retinal thickness significantly decreased (P < 0.0001). At 3 months, complete retinal and subretinal fluid resolution was achieved in 91% of all eyes and complete regression of polypoidal lesions was achieved in 82% of PCV eyes. Iritis occurred in 8 eyes of 8 patients (14%), but resolved using topical or subtenon corticosteroid injection without visual loss in all cases. CONCLUSIONS IVBr for treatment-naïve neovascular AMD was effective in the short-term, achieving significantly improved BCVA, good retinal fluid resolution, and a high rate of polypoidal lesion regression. However, iritis was noted in 14% of patients which may limit use of this drug.
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Affiliation(s)
- Koji Tanaka
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan.
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tamaki Tamashiro
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Makiko Nakayama
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Sorako Wakugawa
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hajime Onoe
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Yu Wakatsuki
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Masashi Ogasawara
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Shintake
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Akiko Yamamoto
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Keiko Kataoka
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Taiji Hasegawa
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiko Izumi
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Moeko Kawai
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ruka Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryusaburo Mori
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
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15
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Sub-Tenon's capsule triamcinolone acetonide injection to prevent brolucizumab-associated intraocular inflammation. Graefes Arch Clin Exp Ophthalmol 2022; 260:2529-2535. [PMID: 35235038 DOI: 10.1007/s00417-022-05611-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the efficacy of sub-Tenon's capsule triamcinolone acetonide (STTA) injections for preventing development of intraocular inflammation (IOI) related to intravitreal injection (IVI) of brolucizumab 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 Forty-four eyes (44 patients) treated with at least one brolucizumab IVI were studied: 14 eyes received brolucizumab IVI alone and 30 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 30 eyes that received combination therapy, the difference of which reached significance (p = 0.012). Regarding combination therapy, the intraocular pressure in three (10%) eyes increased to 22 to about 26 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 7.1 ± 0.4 months. CONCLUSION The results indicated the possible preventative effect of a STTA injection on development of brolucizumab-associated IOI.
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Hsu ST, Ponugoti A, Deaner JD, Vajzovic L. Update on Retinal Drug Toxicities. CURRENT OPHTHALMOLOGY REPORTS 2021; 9:168-177. [PMID: 34956737 PMCID: PMC8688906 DOI: 10.1007/s40135-021-00277-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose of Review This review aims to provide an update on the clinical presentations and diagnostic findings of drug-induced retinal toxicities. Recent Findings Several newly FDA-approved medications have been associated with acute retinal toxicities, including brolucizumab, MEK inhibitors, ulixertinib, and FGFR inhibitors. Additionally, as previously believed-to-be well-tolerated medications, such as pentosan sulfate sodium, anti-retroviral therapies, and certain intraoperative ocular medications, are used more frequently or for longer periods of time, associated toxic retinopathies and inflammatory reactions have been reported. Finally, advances in ocular imaging have revealed novel findings in hydroxychloroquine and tamoxifen maculopathies. Summary Discovery of new medications, increased frequency of use, and longer-term use have led to increased reports of retinal toxicities. Advances in retinal imaging have allowed for earlier detection of subclinical changes associated with these medications, which may help prevent progression of disease. However, more research is needed to determine the point at which vision loss becomes irreversible. Risks and benefits must be assessed prior to discontinuation of the offending, but potentially lifesaving, therapy.
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Affiliation(s)
- S. Tammy Hsu
- Duke University School of Medicine, Durham, NC USA
| | | | | | - Lejla Vajzovic
- Duke University School of Medicine, Durham, NC USA
- Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710 USA
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17
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Shigemoto Y, Sakurada Y, Fukuda Y, Matsubara M, Parikh R, Kashiwagi K. The combination therapy of subtenon triamcinolone acetonide injection and intravitreal brolucizumab for brolucizumab-related intraocular inflammation. Medicine (Baltimore) 2021; 100:e27580. [PMID: 34678906 PMCID: PMC8542137 DOI: 10.1097/md.0000000000027580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Brolucizumab is a novel anti-vascular endothelial growth factor agent with clinical trials demonstrating excellent efficacy for neovascular age-related macular degeneration (AMD) in both visual and anatomic outcomes. However, there is concern of intraocular inflammation (IOI), and we propose concurrent subtenon triamcinolone acetonide (STTA) to prevent IOI. PATIENT CONCERN A 73-year-old man was treated with aflibercept for neovascular AMD in his right eye. Despite 11 months of monthly intravitreal aflibercept injections, optical coherence tomography demonstrated persistent exudation. Ten days following his second brolucizumab injection, the patient presented with decreased vision due to vitritis in his right eye. DIAGNOSIS Brolucizumab-related IOI in neovascular AMD refractory to aflibercept. INTERVENTIONS A combination therapy involving of intravitreal brolucizumab and STTA. OUTCOMES The anti-vascular endothelial growth factor inhibitor was changed back to aflibercept; however, exudation persisted. Therefore, a combination therapy involving STTA (5 mg/0.5 mL) and intravitreal injection of brolucizumab (6.0 mg/0.05 mL) was performed to treat the exudation and as prophylaxis to recurrent IOI. Combination therapy achieved no recurrent IOI and resolution of exudation with 8-week treatment intervals. LESSONS This case might indicate that STTA is not only an optimal treatment option for brolucizumab-related IOI but also a preventive agent for this condition.
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Affiliation(s)
- Yumi Shigemoto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Yoshiko Fukuda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Mio Matsubara
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, NY
- New York University Grossman School of Medicine, New York, NY
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
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Fukuda Y, Sakurada Y, Matsubara M, Hasebe Y, Sugiyama A, Kikushima W, Kashiwagi K. Comparison of Outcomes between 3 Monthly Brolucizumab and Aflibercept Injections for Polypoidal Choroidal Vasculopathy. Biomedicines 2021; 9:biomedicines9091164. [PMID: 34572350 PMCID: PMC8469297 DOI: 10.3390/biomedicines9091164] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
We compared the short-term outcomes between 3-monthly aflibercept and brolucizumab injections for treatment-naïve polypoidal choroidal vasculopathy (PCV). A total of 52 eyes were included. Patients received 3 monthly intravitreal aflibercept (n = 38) or intravitreal brolucizumab (n = 14). Indocyanine green angiography (ICGA) was performed at baseline and at the 3-month visit. Selection of anti-VEGF agents depended on time. In the brolucizumab-treated group, best-corrected visual acuity (BCVA) improved from 0.27 ± 0.34 (log MAR unit) at baseline to 0.20 ± 0.24 at 3-month visit, which is comparable with the aflibercept-treated group (p = 0.87), after adjustment of confounding factors. Central retinal thickness significantly decreased by 43%−44% in both groups. Subfoveal choroidal thickness also significantly decreased by 20.5% during this interval in the brolucizumab-treated group, which was greater than the aflibercept-treated group. The complete resolution rate of polypoidal lesions on ICGA was significantly higher (p = 0.043) in the brolucizumab-treated group (78.6%) than in the aflibercept-treated group (42.1%). Intraocular inflammation was observed in 14.3% (2/14) in the brolucizumab-treated group only. In short-term follow-up, intravitreal injection of 3-monthly brolucizumab was comparable with aflibercept in terms of BCVA and morphological improvement along with higher resolution of polypoidal lesion(s) on ICGA.
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Affiliation(s)
| | - Yoichi Sakurada
- Correspondence: ; Tel.: +81-55-273-9657; Fax: +81-55-273-6757
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