Tearing of the Retinal Pigment Epithelium after Intravitreal Injection of Brolucizumab

Abstract

Purpose: To report tearing of the retinal pigment epithelium (RPE) that occurred after intravitreal injection of brolucizumab for polypoidal choroidal vasculopathy (PCV) with pigment epithelial detachment (PED).Case summary: A 68-year-old man presented to our clinic with a 1-week history of decreased visual acuity in the left eye. His best-corrected visual acuity (BCVA) was 0.2 in the left eye. Fundus photography and optical coherence tomography (OCT) revealed PED and subretinal fluid (SRF). PCV was diagnosed based on the fluorescein angiography finding of a nonspecific hyperfluorescent lesion; indocyanine green angiography revealed a branching vascular network with a dilated polypoidal hyperfluorescent lesion at the end. Thus, the patient underwent intravitreal injection of brolucizumab. At the 2-week follow-up, PED and SRF were both reduced but a tear was present in the RPE; the patient’s visual acuity had not improved. After two further intravitreal injections of brolucizumab, OCT showed decreases in SRF and PED; BCVA remained stable at 0.2 without improvement.Conclusions: Tearing of the RPE is a rare complication that can occur after intravitreal injection of current anti-vascular endothelial growth factor agents. Clinicians should carefully consider the potential for tearing of the RPE after intravitreal injection of brolucizumab.