Delayed noninfectious intraocular inflammation and retinal vasculitis after single intravitreal Brolucizumab® injection for polypoidal choroidal vasculopathy

Abstract

A 52-year-old woman with extrafoveal polypoidal choroidal vasculopathy (PCV) in her right eye was treated with a single intravitreal injection of 6 mg/0.05 ml brolucizumab (BZB) and focal thermal laser therapy. The patient complained of redness and blurred vision in her right eye for the previous week at the 4-week follow-up visit. PCV-related clinical findings revealed complete regression. There was circumcorneal congestion, diffuse nongranulomatous keratic precipitates, grade 2+ anterior chamber flare and cells, grade 1+ vitreous haze, posterior vitreous cells, hyperemic disc with perivascular sheathing, and retinal vasculitis. Following treatment with topical and systemic steroids, the intraocular inflammation (IOI) worsened, and vision was reduced to 6/60 after a week of steroid therapy at a subsequent follow-up visit. A pars plana vitrectomy was performed, and vitreous cytology revealed small lymphocytes with no evidence of intraocular infection. At the 6-month follow-up visit, the patient’s vision had improved to 6/6 and the signs of IOI had resolved. This case demonstrates that even after a single intravitreal injection of BZB, an eye that had previously received no antivascular endothelial growth factor injection can develop IOI.