Retinal Occlusive Vasculitis after Intravitreal Brolucizumab Injection for Wet Age-related Macular Degeneration

Purpose: This report describes a case of retinal occlusive vasculitis, following intraocular inflammation, after an intravitreal injection of brolucizumab, which was diagnosed and treated promptly.Case Summary: A 73-year-old woman with no prior underlying diseases presented with wet age-related macular degeneration, which had been diagnosed in her right eye 10 months prior. Due to increased disease activity despite five previous intravitreal aflibercept injections, treatment was switched to brolucizumab. Seven weeks after treatment, anterior chamber inflammation was observed; treatment consisted of steroid eye drops. Five weeks later, the patient experienced decreased visual acuity and central scotoma in her right eye. Fundus examination revealed retinal whitening and arterial sheathing. Optical coherence tomography showed inner retinal hyper-reflectivity. Fluorescein angiography indicated a retinal arterial filling defect and hypo-fluorescence around retinal vessels in the early phase and hyper-fluorescence at the optic disc in the late phase. Consequently, the patient was diagnosed with retinal occlusive vasculitis after brolucizumab injection. Treatment included subtenon triamcinolone acetonide injection and oral steroids, which led to resolution of the retinal arterial sheathing and whitening. The patient remains under observation without new complications, other than atrophy in the area previously affected by retinal whitening.Conclusions: Retinal occlusive vasculitis can occur in older patients without any underlying health conditions. In cases preceded by intraocular inflammation, follow-up intervals should be shortened to enable early diagnosis and prompt treatment.