Abstract:We present a case of Brolucizumab induced intraocular inflammation with occlusive vasculitis that worsened with Brolucizumab re-challenge. A 68-year-old lady, with no comorbidity was diagnosed with left eye (LE) polypoidal choroidal vasculopathy (PCV) with initial visual acuity of 1/60. Patient had previously received multiple doses of other anti-vascular endothelial growth factor (anti VEGF) injections in left eye and was switched to Brolucizumab.
After second dose, vision in left eye improved to 3/60 but patient was incidentally diagnosed to have Brolucizumab induced retinal vasculitis on routine examination. The patient had inferior arterial occlusion without any vitritis/anterior segment inflammation. Patient was successfully treated with short course of topical and oral steroids combination.
Brolucizumab re-challenge was given to the patient under steroid cover. 1 week after third dose, patient complained of acute diminution of vision. On examination, vision in the left eye dropped to hand movements (HM). The left eye developed diffuse anterior episcleritis and fundus examination showed +2 vitritis and worsening of vasculitis. After ruling out infective etiologies, the patient was again started on systemic steroids. Satisfied with recovery, the patient abruptly stopped the medication herself at 2 weeks that worsened the inflammation. She underwent extensive systemic work up to rule out any other infective/inflammatory foci. The patient was again started on oral Prednisolone 80 mg/d with topical steroids which was slowly tapered over 2 months resulting in resolution.
Although Brolucizumab associated intraocular inflammation responds well to steroid therapy and have a short course, the intraocular inflammation (IOI) worsened following re-challenge and was associated with a more protracted course of episcleritis and vasculitis in our case.
