Supplementary Material for: Vitreous Noise on Optical Coherence Tomography as an Early Finding of Brolucizumab-Related Intraocular Inflammation

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.

本文报道1例在患者出现任何主观症状前，通过光学相干断层扫描（optical coherence tomography, OCT）检出的玻璃体细胞雾状浑浊相关的布罗利珠单抗相关性眼内炎症（intraocular inflammation, IOI）病例。1例69岁女性因右眼视力下降就诊，被诊断为厚脉络膜新生血管病变，初始接受玻璃体内注射阿柏西普（intravitreal aflibercept, IVA）联合3+治疗延长方案（treat-and-extend, TAE）。尽管IVA治疗后浆液性视网膜脱离（serous retinal detachment, SRD）完全消退，但患者仍维持每4周1次的治疗频率，未延长治疗间隔。为缩短治疗间隔，在初始IVA治疗44周后，换用玻璃体内注射布罗利珠单抗（intravitreal brolucizumab, IVBr）。启动IVBr治疗后，SRD完全消退。但在IVBr治疗启动16周后，OCT检查显示玻璃体腔出现此前未观察到的浑浊噪声，红外成像显示黄斑区出现黑色烟雾状阴影。尽管存在上述影像学表现，但患者无任何主观不适，故以8周的TAE治疗间隔再次给予IVBr注射。再次IVBr治疗5天后，观察到玻璃体内出现炎性细胞，同时玻璃体腔浑浊噪声及红外成像的烟雾状阴影进一步加重。临床确诊为布罗利珠单抗相关性IOI，并启动抗炎治疗。经规范抗炎治疗后，玻璃体浑浊逐渐消退，OCT下的玻璃体腔噪声及红外成像的黑色烟雾状阴影均消失。本研究提示，在初始IVBr治疗16周时（即我们判断无炎症并再次给予IVBr注射的时间点），IOI可能已悄然存在。在接受IVBr治疗的患者随访过程中，通过评估玻璃体雾状浑浊，可借助OCT更早地检出IOI。