Case of the Month I December 2020

Case of the Month
December 22, 2020

The Case

There was a choroidal neovascular membrane in each eye with ill-defined late leakage, which prompted anti-VEGF therapy. Both eyes developed sterile inflammation after Beovu treatments, and the medication was discontinued. The left eye developed a central retinal artery occlusion 5 ½ weeks after Beovu and 4 days after Eylea treatment. There was partial sparing of the fovea by a cilioretinal artery, which reduced the degree central visual loss.

Occlusion of retinal arteries is a rare but often visually devastating side-effect of Beovu treatment. Branch retinal arteries are most commonly involved, but central retinal occlusions have also been reported. (1,2) A review of HAWK/HARRIER data revealed a 2.1% incidence of occlusive retinal vasculitis among patients receiving Beovu. Moderate or severe visual acuity loss occurred in 8 subjects (0.74% of study subjects). Of these, 5 experienced visual loss within the first 3 months and 7 within the first 6 months. (3)

It is possible that the CRAO in our patient had a different etiology. Though he denied signs or symptoms of giant cell arteritis, sed rate, C-reactive protein, and complete blood count were obtained. The results were unremarkable. Carotid ultrasonography revealed bilateral carotid artery plaque formation without significant stenosis. Echocardiography was unremarkable.

1. Baumal CR, Spaide RF, Vajzovic L, et al. Retinal vasculitis and intraocular inflammation after intravitreal injection of brolucizumab. Ophthalmol 2020;127:1345-1359.

2. Witkin AJ, Hahn P, Murray TG, et al. Occlusive retinal vasculitis following intravitreal brolucizumab. J Vitreoretin Dis 2020;4:269-279.

3. Monés J, Srivastava SK, Jaffe GJ, et al. Risk of inflammation, retinal vasculitis and retinal occlusion-related events with brolucizumab: post-hoc review of HAWK and HARRIER. Ophthalmol 2020 (online prior to print).

Case Photos

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There was a choroidal neovascular membrane in each eye with ill-defined late leakage, which prompted anti-VEGF therapy. Both eyes developed sterile inflammation after Beovu treatments, and the medication was discontinued. The left eye developed a central retinal artery occlusion 5 ½ weeks after Beovu and 4 days after Eylea treatment. There was partial sparing of the fovea by a cilioretinal artery, which reduced the degree central visual loss.

Occlusion of retinal arteries is a rare but often visually devastating side-effect of Beovu treatment. Branch retinal arteries are most commonly involved, but central retinal occlusions have also been reported. (1,2) A review of HAWK/HARRIER data revealed a 2.1% incidence of occlusive retinal vasculitis among patients receiving Beovu. Moderate or severe visual acuity loss occurred in 8 subjects (0.74% of study subjects). Of these, 5 experienced visual loss within the first 3 months and 7 within the first 6 months. (3)

It is possible that the CRAO in our patient had a different etiology. Though he denied signs or symptoms of giant cell arteritis, sed rate, C-reactive protein, and complete blood count were obtained. The results were unremarkable. Carotid ultrasonography revealed bilateral carotid artery plaque formation without significant stenosis. Echocardiography was unremarkable.

1. Baumal CR, Spaide RF, Vajzovic L, et al. Retinal vasculitis and intraocular inflammation after intravitreal injection of brolucizumab. Ophthalmol 2020;127:1345-1359.

2. Witkin AJ, Hahn P, Murray TG, et al. Occlusive retinal vasculitis following intravitreal brolucizumab. J Vitreoretin Dis 2020;4:269-279.

3. Monés J, Srivastava SK, Jaffe GJ, et al. Risk of inflammation, retinal vasculitis and retinal occlusion-related events with brolucizumab: post-hoc review of HAWK and HARRIER. Ophthalmol 2020 (online prior to print).

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