case_images: PMC11758747_01
case_images: Fundus findings on ultra-widefield fundus photography after intravitreal injection of brolucizumab. Ultra-widefield fundus photography shows partial retinal vascular occlusion (white arrowhead) and perivascular hemorrhage (white arrows) without retinal vessel whitening, suggesting mild intraocular inflammation
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case_images: PMC11758747_01_12886_2024_3827_Fig1_HTML.jpg
case_images: Fig1
case_images: Following two injections of brolucizumab, a slit-lamp examination revealed anterior chamber cells (1+) and fine corneal precipitates without hypopyon and ultra-widefield color fundus images (Optos California, Nikon) demonstrated retinal vascular occlusion and perivascular hemorrhage at the nasal periphery, which suggested the occurrence of a mild non-infections IOI (Fig. 1).
case_images: Baseline fundus findings on ultra-widefield fundus photography and optical coherence tomography (OCT) after aflibercept 2 mg and before aflibercept 8 mg. (a) Ultra-widefield fundus photography shows perivascular hemorrhage (white arrows) and subretinal hemorrhage (white arrowhead). (b) OCT of an oblique section demonstrated subretinal fluid (SRF) and a large sub-retinal pigment epithelium (RPE) fluid before intravitreal injection of aflibercept 8 mg
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case_images: PMC11758747_01_12886_2024_3827_Fig2_HTML.jpg
case_images: Fig2
case_images: SRF remained on OCT (Fig. 2b), and BCVA further decreased to 20/200, indicating that macular exudation showed no improvement and remained refractory to treatment. Sixteen weeks after the final brolucizumab treatment and five weeks after switching to aflibercept 2 mg, when the IOI was confirmed to subside, we decided to switch to aflibercept 8 mg after careful discussion, expecting efficacy and safety.
case_images: Slit-lamp examination and ultra-widefield fundus photography and ultra-widefield fluorescein angiography and optical coherence tomography (OCT) after intravitreal injection of aflibercept 8 mg. (a) Slit-lamp examination shows fine keratic precipitates and anterior chamber cells (1+) without hypopyon. (b) Ultra-widefield fundus photography shows whitening of retinal vessels at the nasal periphery (white arrowhead), and blot retinal hemorrhages around the peripheral vessels and vitreous opacities were also observed. (c) Ultra-widefield fluorescein angiography in the early phase showed a filling delay of peripheral retinal veins (white arrowheads) and multiple focal stenoses of retinal veins (white arrows). (d) Ultra-widefield fluorescein angiography in the late phase shows mild leakage from retinal veins and staining in the venous wall (white arrows). (e) OCT showed significant improvement, with the disappearance of SRF and a reduction in sub-RPE fluid size after intravitreal injection of aflibercept 8 mg
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case_images: PMC11758747_01_12886_2024_3827_Fig3_HTML.jpg
case_images: Fig3
case_images: Slit-lamp examination showed mild conjunctival injection, anterior chamber cells (1+), fine keratic precipitates (Fig. 3a), and vitreous cells (1+) without hypopyon. Ultra-widefield color fundus images showed whitening of retinal vessels on the nasal side of the optic nerve and blot retinal hemorrhages around these vessels (Fig. 3b). Ultra-widefield fluorescein angiography showed delayed filling of peripheral retinal veins, multiple retinal vein stenoses in the early phase (Fig. 3c), and mild retinal vein leakage in the late phase (Fig. 3d). Although IOI developed after aflibercept 8 mg, macular exudation, including large sub-RPE fluid, improved on OCT significantly (Fig. 3e).