We describe a case of brolucizumab-related intraocular inflammation (IOI) detected using vitreous haze on optical coherence tomography (OCT) at an early stage before the patient was aware of any symptom. A 69-year-old female presented with decreased right vision. The patient was diagnosed with pachychoroidal neovasculopathy and started intravitreal aflibercept (IVA) with a 3+ treat-and-extend strategy (TAE). Although the serous retinal detachment (SRD) disappeared after IVA treatment, the patient was managed with treatment every 4 weeks without extending the treatment interval To shorten the treatment interval, intravitreal brolucizumab (IVBr) was started 44 weeks after starting IVA treatment. After initiating IVBr treatment, the SRD completely disappeared. However, 16 weeks after starting IVBr, OCT showed noise in the vitreous cavity, which had not been seen before, and infrared images showed a black smoke-like shadow over the macula. Despite these findings, the patient had no subjective symptoms, and so IVBr was re-administered with an 8-week TAE interval. Five days after IVBr treatment, vitreous inflammatory cells were observed, and the noise in the vitreous cavity and the smoke-like shadow in the infrared image were further enhanced. We diagnosed the patient with brolucizumab-related IOI, and anti-inflammatory treatment was initiated. After extensive treatment, the vitreous opacity gradually disappeared, and the vitreous noise on OCT and the black smoke-like shadow on infrared images disappeared. IOI may have already been present 16 weeks after starting IVBr treatment, when we judged that there was no inflammation and IVBr was re-administered. When following patients receiving IVBr, IOI may be detected by OCT at an earlier stage by evaluating vitreous haze.
Case Rep Ophthalmol 2021;12:797–803

中文翻译：

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光学相干断层扫描的玻璃体噪声作为 Brolucizumab 相关眼内炎症的早期发现

我们描述了一个在患者意识到任何症状之前使用光学相干断层扫描 (OCT) 上的玻璃体混浊检测到的 Brolucizumab 相关眼内炎症 (IOI) 的病例。一名 69 岁女性因右视力下降就诊。该患者被诊断为厚脉络膜新血管病变，并开始玻璃体内阿柏西普 (IVA) 治疗，并采用 3+ 治疗和延长策略 (TAE)。尽管 IVA 治疗后浆液性视网膜脱离 (SRD) 消失，但患者每 4 周接受一次治疗，没有延长治疗间隔 为缩短治疗间隔，在开始 IVA 治疗后 44 周开始玻璃体内注射 Brolucizumab (IVBr)。开始 IVBr 治疗后，SRD 完全消失。然而，在开始 IVBr 后 16 周，OCT 显示玻璃体腔内有噪音，这是以前从未见过的，红外图像显示黄斑上有黑色烟雾状阴影。尽管有这些发现，但患者没有主观症状，因此以 8 周的 TAE 间隔重新给予 IVBr。IVBr治疗后5天，观察到玻璃体炎性细胞，玻璃体腔内的噪声和红外图像中的烟状阴影进一步增强。我们诊断出该患者患有与 brolucizumab 相关的 IOI，并开始抗炎治疗。经过大量治疗，玻璃体混浊逐渐消失，OCT上玻璃体噪声和红外图像上的黑烟状阴影消失。IOI 可能在开始 IVBr 治疗 16 周后已经存在，当时我们判断没有炎症并重新给予 IVBr。
Case Rep Ophthalmol 2021；12:797–803