Occlusive Retinal Vasculitis Following Intravitreal Brolucizumab

Witkin, André J.; Hahn, Paul; Murray, Timothy G.; Arévalo, J. Fernando; Blinder, Kevin J.; Choudhry, Netan; Emerson, Geoff G; Goldberg, Roger A.; Kim, Stephen J.; Pearlman, Joel; Schneider, Eric; Tabandeh, Homayoun; Wong, Robert W.

doi:10.1177/2474126420930863

Cited by 137 publications

(254 citation statements)

References 18 publications

Supporting

Mentioning

220

Contrasting

Unclassified

Order By: Relevance

“…In brolucizumab’s case, the high rate of SII may result from its higher rates of anti-brolucizumab antibodies in serum compared to other anti-VEGF medications. The HAWK and HARRIER trials found these antibodies were present in 36 to 52% of patients even before initiation of brolucizumab therapy [ 12 , 52 , 53 , 54 ]. Once the treatment was started, this increased to 53 to 67% [ 12 , 52 , 53 , 54 ].…”

Section: Sterile Intraocular Inflammationmentioning

confidence: 99%

Inflammatory Complications of Intravitreal Anti-VEGF Injections

Cox

Eliott

Sobrin

2021

JCM

View full text Add to dashboard Cite

Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents is a commonly used therapy for numerous retinal diseases. The most commonly used of these medications are bevacizumab, ranibizumab, aflibercept, and brolucizumab. However, intravitreal administration of these agents is also associated with several inflammatory and non-inflammatory adverse events. The three inflammatory adverse events are sterile intraocular inflammation, brolucizumab-associated retinal vasculitis, and post-injection endophthalmitis. This narrative review summarizes the current literature regarding these conditions, including their epidemiology, presentation, management, outcomes, and pathogenesis. The inflammatory adverse events also share a number of overlapping features, which can make them difficult to discern from one another in a clinical context. This review discusses certain distinguishing features of these conditions that may aid providers in discerning between them and establishing the correct diagnosis.

show abstract

Section: Sterile Intraocular Inflammationmentioning

confidence: 99%

Inflammatory Complications of Intravitreal Anti-VEGF Injections

Cox

Eliott

Sobrin

2021

JCM

View full text Add to dashboard Cite

show abstract

“…Recently, outbreaks of intraocular inflammation with obstructive retinal vasculitis were reported after brolucizumab was administered via the intravitreal route. Patients and physicians are thus highly wary of this complication [ 200 , 201 , 202 ]. These inflammatory adverse events, which could be caused by any intraocular drug, will also be carefully monitored by the regulatory authorities.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Ocular Drug Delivery to the Retina: Current Innovations and Future Perspectives

2021

View full text Add to dashboard Cite

Treatment options for retinal diseases, such as neovascular age-related macular degeneration, diabetic retinopathy, and retinal vascular disorders, have markedly expanded following the development of anti-vascular endothelial growth factor intravitreal injection methods. However, because intravitreal treatment requires monthly or bimonthly repeat injections to achieve optimal efficacy, recent investigations have focused on extended drug delivery systems to lengthen the treatment intervals in the long term. Dose escalation and increasing molecular weight of drugs, intravitreal implants and nanoparticles, hydrogels, combined systems, and port delivery systems are presently under preclinical and clinical investigations. In addition, less invasive techniques rather than intravitreal administration routes, such as topical, subconjunctival, suprachoroidal, subretinal, and trans-scleral, have been evaluated to reduce the treatment burden. Despite the latest advancements in the field of ophthalmic pharmacology, enhancing drug efficacy with high ocular bioavailability while avoiding systemic and local adverse effects is quite challenging. Consequently, despite the performance of numerous in vitro studies, only a few techniques have translated to clinical trials. This review discusses the recent developments in ocular drug delivery to the retina, the pharmacokinetics of intravitreal drugs, efforts to extend drug efficacy in the intraocular space, minimally invasive techniques for drug delivery to the retina, and future perspectives in this field.

show abstract

“…Of the 36 subjects with intraocular inflammation and vasculitis, 23 subjects (2.1%) had concomitant vascular occlusion [ 157 ]. The American Society of Retina Specialists (ASRS) conducted a postapproval analysis of brolucizumab-associated retinal vasculitis after cases [ 158 ]. Retinal vasculitis was reported in 26 eyes of 25 patients after treatment with brolucizumab (of which 85% were designated as occlusive).…”

Section: Treatment Strategies Of Dmementioning

confidence: 99%

“…Retinal vasculitis was reported in 26 eyes of 25 patients after treatment with brolucizumab (of which 85% were designated as occlusive). Twelve eyes (46%) had a greater than 3-line decrease in VA at the final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse [ 158 ]. Additionally, a retrospective case series found that retinal vasculitis and intraocular inflammation after intravitreal injection of brolucizumab were characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities [ 159 ].…”

Section: Treatment Strategies Of Dmementioning

confidence: 99%

Intravitreal Therapy for Diabetic Macular Edema: An Update

Furino

Boscia

Reibaldi

et al. 2021

Journal of Ophthalmology

View full text Add to dashboard Cite

Diabetic macular edema (DME) represents a prevalent and disabling eye condition. Despite that DME represents a sight-threatening condition, it is also among the most accessible to treatment. Many different treatment options including photocoagulation, intravitreal medical treatment (either vascular endothelial growth factor inhibitors or corticosteroids therapies), and surgical removal are currently available. Although laser has been considered as the gold standard for many years, over the past several years vascular endothelial growth factor inhibitors (anti-VEGFs) have become first-line therapy. However, many patients do not adequately respond to them. With the development of sustained-release corticosteroid devices, steroids have gained a presence in the management of the DME. We review and update the role of anti-VEGF and intravitreal sustained-release corticosteroid management of DME. According to the currently available scientific evidence, the choice of one anti-VEGF over another critically depends on the baseline best-corrected visual acuity (BCVA). While aflibercept may be the drug of choice in low baseline BCVA, the three anti-VEGFs (bevacizumab, ranibizumab, and aflibercept) provided similar functional outcomes when the baseline BCVA was higher. DEX implants are a valuable option for treating DME, although they are usually seen as a second choice, particularly in those eyes that have an insufficient response to anti-VEGF. The new evidence suggested that, in eyes that did not adequately respond to anti-VEGF, switching to a DEX implant at the time to 3 monthly anti-VEGF injections provided better functional outcomes.

show abstract

Occlusive Retinal Vasculitis Following Intravitreal Brolucizumab

Cited by 137 publications

References 18 publications

Inflammatory Complications of Intravitreal Anti-VEGF Injections

Inflammatory Complications of Intravitreal Anti-VEGF Injections

Ocular Drug Delivery to the Retina: Current Innovations and Future Perspectives

Intravitreal Therapy for Diabetic Macular Edema: An Update

Contact Info

Product

Resources

About