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Case Reports
. 2024 Feb 29;18(1):80.
doi: 10.1186/s13256-024-04402-9.

Scleritis following intravitreal brolucizumab injection: a case series

Takuya Takayama  1 , Satoru Inoda  2 , Hidenori Takahashi  1 , Rika Tsukii  1 , Hana Yoshida  1 , Yuka Kasuya  1 , Kosuke Nagaoka  1 , Ryota Takahashi  1 , Yusuke Arai  1 , Hidetoshi Kawashima  1
Affiliations
Case Reports

Scleritis following intravitreal brolucizumab injection: a case series

Takuya Takayama et al. J Med Case Rep. .

Abstract

Background: This study reports the first cases of scleritis following intravitreal brolucizumab (IVBr) injection for nAMD, emphasizing the need to be aware of the possibility of scleritis following IVBr injections.

Case presentation: Case 1. A 74-year-old Japanese man with nAMD complained of conjunctivitis and decreased vision in the right eye 8 days after his eighth IVBr injection. Examination revealed scleritis without anterior inflammation. Topical 0.1% betamethasone and 0.3% gatifloxacin eye drops were started. The scleritis worsened in the following 2 weeks and became painful. He underwent sub-Tenon's capsule triamcinolone acetonide (STTA) injection. Two days later, he returned with a complaint of severe vision loss. Fundus examination revealed retinal artery occlusion, vasculitis, and vitreous opacity in the right eye. Vitreous surgery was performed.

Case 2: An 85-year-old Japanese woman with nAMD in the right eye complained of reddening of the eye 27 days after her fifth IVBr injection. Examination showed conjunctivitis and scleritis without anterior inflammation in the right eye. She was started on 0.1% fluorometholone and 0.5% levofloxacin hydrate eye drops. The scleritis worsened in the following 3 weeks. Her treatment was switched to 0.1% betamethasone eye drops. One month later, the scleritis had improved and a sixth IVBr injection was administered. There was no worsening of the scleritis at that time. However, 1 month after a seventh IVBr injection, she complained of severe hyperemia and decreased vision. Fundus examination revealed vitreous opacification. She underwent STTA, and the vitreous opacity improved in 24 days. Case 3. A 57-year-old Japanese man with nAMD complained of pain and decreased vision in the right eye 21 days after a fourth IVBr injection. Examination revealed scleritis with high intraocular pressure but no anterior chamber or fundus inflammation. STTA and topical eye drops were performed. One month later, scleritis improved but visual acuity didn't due to progression of nAMD.

Conclusions: Intraocular inflammation following IVBr injection may progress to the posterior segment. Scleritis can occur after IVBr injection, and topical eye drops alone may not be sufficient for initial treatment. Clinicians should consider the possibility of scleritis in patients with worsening inflammation after IVBr injection.

Keywords: Brolucizumab; Case report; Intraocular inflammation; Scleritis.

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Conflict of interest statement

The following authors have no financial disclosures: T.T., R.T., H.Y., Y.K., R.T. S.I.: Lecturer’s fees from Kowa and Novartis and grants from Novartis, outside this work. H.T.: Patent pending of this work; lecturer’s fees from Santen, Kowa, Senju, Novartis, and Bayer; grants from Senju, Novartis, and Bayer; a founder of DeepEyeVision, Inc.; patents outside this work. K.N: Lecturer’s fees from Novartis outside this work. Y.A.: Lecturer’s fees from Santen, Kowa, Senju, and Bayer; grants from Heiwa-Iyo, Novartis and Bayer outside this work. H.K.: Lecturer’s fees from Otsuka, Senju, Mitsubishi-Tanabe, Kowa, Santen, Novartis, and Zeiss; grants from Senju, Linical, DeepEyeVision, HOYA, Santen, Heiwa-Iyou, and Bayer, outside this work.

Figures

Fig. 1
Fig. 1
Clinical findings in Case 1. A Significant upper scleritis was observed in the right eye after the eighth intravitreal brolucizumab injection. B Fundus angiography shows delayed inflow and peripheral arterial occlusion. Fundus photograph of the right eye shows vitreous opacity and retinal whitening in the upper and temporal macular. C Retinal artery occlusion has occurred, and slight hyperreflectivity of the inner nuclear layer is seen in the macula (white arrow). D Scleritis and vitreous opacity improved
Fig. 2
Fig. 2
Clinical findings in Case 2. A Significant upper scleritis was observed in the right eye after the fifth intravitreal brolucizumab injection. B Scleritis improved after treatment with topical eye drops. C Upper scleritis worsened after the seventh intravitreal brolucizumab injection. D There was vitreous opacification but no retinal vasculitis or retinal vascular occlusion. The optical coherence tomography image was unclear because of vitreous opacification. E Scleritis and vitreous opacity improved
Fig. 3
Fig. 3
Clinical findings in Case 3. A Scleritis was observed after a fourth intravitreal brolucizumab injection. B Fundus images shows no vitreous opacity. C Fluorescein angiography and indocyanine green angiography did not show retinal vasculitis or retinal vascular occlusion. Optical coherence tomography showed fibrosis at the fovea centralis. D Scleritis gradually improved
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References

    1. Oshima Y, Ishibashi T, Murata T, Tahara Y, Kiyohara Y, Kubota T. Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol. 2001;85(10):1153–1157. doi: 10.1136/bjo.85.10.1153. - DOI - PMC - PubMed
    1. Li E, Donati S, Lindsley KB, Krzystolik MG, Virgili G. Treatment regimens for administration of anti-vascular endothelial growth factor agents for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2020;5(5):CD012208. - PMC - PubMed
    1. Patil NS, Dhoot AS, Popovic MM, Kertes PJ, Muni RH. Risk of intraocular inflammation after injection of antivascular endothelial growth factor agents: a meta-analysis. Retina. 2022;42(11):2134–2142. doi: 10.1097/IAE.0000000000003582. - DOI - PubMed
    1. Monés J, Srivastava SK, Jaffe GJ, Tadayoni R, Albini TA, Kaiser PK, et al. Risk of inflammation, retinal vasculitis, and retinal occlusion-related events with brolucizumab: post hoc review of HAWK and HARRIER. Ophthalmology. 2021;128(7):1050–1059. doi: 10.1016/j.ophtha.2020.11.011. - DOI - PubMed
    1. Matsumoto H, Hoshino J, Mukai R, Nakamura K, Akiyama H. Short-term outcomes of intravitreal brolucizumab for treatment-naïve neovascular age-related macular degeneration with type 1 choroidal neovascularization including polypoidal choroidal vasculopathy. Sci Rep. 2021;11(1):6759. doi: 10.1038/s41598-021-86014-7. - DOI - PMC - PubMed

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