Proactive Post-Injection Monitoring in Brolucizumab Therapy: A Study on Intraocular Inflammation and Treatment Outcomes

Manoj Soman,1,2 Apoorva Jadhav,1,2 Abhaya Balakrishnan,1,2 Jay U Sheth,3 Unnikrishnan Nair1,2 1Department of Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, India; 2Department of Research, Chaithanya Innovation in Technology and Eye care (Research), Trivandrum, India; 3Department of Retina, Shantilal Shanghvi Eye Institute, Mumbai, IndiaCorrespondence: Jay U Sheth, Department of Retina, Shantilal Shanghvi Eye Institute, CS No: 3/207, 4/207, RJ Gaikwad Road, Barkat Ali Dargah Road, Wadala East, Mumbai, Maharashtra, 400037, India, Tel +91-9961167200, Email [email protected]: Intravitreal anti-VEGF agents, such as Brolucizumab, play a crucial role in treating neovascular age-related macular degeneration (nAMD) and Polypoidal choroidal vasculopathy (PCV). While Brolucizumab offers advantages like extended duration and fewer injections, concerns about intraocular inflammation (IOI) have emerged. This study evaluates the outcomes of a proactive monitoring protocol for Brolucizumab-treated eyes with resistant nAMD and PCV.Patients and Methods: A single-center retrospective study analyzed patients treated with Brolucizumab for resistant nAMD and PCV. Data on demographics, visual outcomes and IOI incidence, with the latter being confirmed by clinicians. Additional data on management strategies and follow-up adherence were also analyzed. Proactive monitoring included telephonic follow-up on day one and mandatory clinic visits on days 15 and 30. Retreatment followed a pro-re-nata (PRN) approach based on fluid persistence or visual acuity loss.Results: Between February 2022 and September 2024, 311 Brolucizumab injections were administered to 144 eyes of 121 patients, with a mean follow-up of 8.6 months. IOI occurred in 7 eyes (4.9%), with a mean onset of 32.1 days. According to the HAWK and HARRIER discomfort grading scale, IOI was categorized as mild in 2 eyes (28.6%), moderate in 3 eyes (42.9%), and severe in 2 eyes (28.6%). Symptoms varied, including blurred vision, floaters, redness, and ocular pain. Inflammation was managed with topical and oral steroids, with resolution in 6 weeks for vasculitis and 9 weeks for vitritis, and no cases required intravitreal agents or vitrectomy. Visual acuity improved or remained stable for most, except in one case of persistent vitritis.Conclusion: This study highlights the incidence of IOI with Brolucizumab in a real-world setting, emphasizing the importance of proactive monitoring and early intervention. Despite the occurrence of inflammation, visual outcomes were generally favorable, supporting the safety of Brolucizumab when managed carefully.Keywords: brolucizumab, intraocular inflammation, proactive monitoring