Occlusive Retinal Vasculitis After Aflibercept 8mg Injection for Wet Macular Degeneration

Abstract

Purpose: To describe a case of occlusive retinal vasculitis (ORV) following intravitreal aflibercept 8mg injection for wet macular degeneration.

Methods: Retrospective, interventional case report.

Results: A 72-year-old female presented with classic ORV 11 days after intravitreal aflibercept 8mg injection in her left eye for wet macular degeneration. Visual acuity (VA) declined from 20/30 to 20/400. Laboratory investigations including Gram stain and cultures of vitreous aspirate, studies for infectious and non-infectious uveitis and hypercoagulable state were all negative. Oral prednisone, sub-Tenon's triamcinolone acetonide (STTA), intravitreal dexamethasone and antibiotic injections, and topical steroids resulted in visual and anatomic improvement. ORV recurred when prednisone was tapered to 10mg/day and was controlled with additional STTA, oral solumedrol, and a 0.18mg fluocinolone acetonide implant. Subsequently exudation from wet macular degeneration recurred and responded to intravitreal faricimab with recovery to 20/30.

Conclusions: ORV is a rare complication of some intravitreal anti-VEGF medications and infectious causes of endophthalmitis. It can be managed with aggressive steroid treatment for an excellent visual outcome in some cases, although the disease may be chronic or recurrent.

Keywords: Aflibercept 8mg; Fluocinolone; Intraocular Inflammation; Non-infectious Posterior Uveitis; Occlusive Retinal Vasculitis; Retinal Vasculitis; Wet Macular Degeneration.