Short-term outcomes of intraocular inflammation after brolucizumab injection in Japanese patients with neovascular age-related macular degeneration

Abstract Purpose This study investigates the short-term outcomes of neovascular age-related macular degeneration (nAMD) patients who developed intraocular inflammation (IOI) after intravitreal brolucizumab injection (IVBr). Methods We studied 285 eyes of 279 cases diagnosed with nAMD and focused on 18 eyes of 17 cases (6.3%) which developed IOI after IVBr. IVBr was performed either on the initial treatment or for switching of other anti-vascular endothelial growth factor agents during January 2020 to December 2021. We evaluated clinical features and the course of treatment of a 6-month follow-up after IOI occurred. Results The average age was 76 years old. Of 17 cases, 9 cases were male, 8 cases were female. Baseline log MAR visual acuity (VA) was 0.36, VA before IOI occurred was 0.30, and VA when IOI occurred was 0.43. 16 eyes had symptoms such as visual loss or floaters when IOI occurred. On the other hand, the remaining 2 eyes had no symptoms. 11 eyes had only IOI, while the remaining 7 eyes had IOI and perivascular sheathing. Steroid sub-tenon injection was performed on 1 eye, steroid eye drops were used in 11 eyes, and 6 eyes were followed-up without treatment. nAMD recurred in 16 eyes after IOI occurred and were treated with aflibercept. VA at 3 and 6 months after IOI occurred were significantly improved to 0.34 and 0.30, respectively (P = 0.09 at 3 months and P = 0.02 at 6 months). The symptoms of patients were improved in all cases. We were able to stop steroid treatment in all cases. Conclusions IOI occurred in 6.3% of nAMD patients after IVBr treatment. All of which showed improvement with steroid treatment or without any treatment. We should consider the possibility of IOI after IVBr as a complication, however, they have a relatively good prognosis if treated at an early stage.