• Yumi Shigemoto, Yoichi Sakurada, Yoshiko Fukuda, Mio Matsubara, Ravi Parikh, and Kenji Kashiwagi.
• Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan.
• Medicine (Baltimore). 2021 Oct 22; 100 (42): e27580e27580.

RationaleBrolucizumab is a novel anti-vascular endothelial growth factor agent with clinical trials demonstrating excellent efficacy for neovascular age-related macular degeneration (AMD) in both visual and anatomic outcomes. However, there is concern of intraocular inflammation (IOI), and we propose concurrent subtenon triamcinolone acetonide (STTA) to prevent IOI.Patient ConcernA 73-year-old man was treated with aflibercept for neovascular AMD in his right eye. Despite 11 months of monthly intravitreal aflibercept injections, optical coherence tomography demonstrated persistent exudation. Ten days following his second brolucizumab injection, the patient presented with decreased vision due to vitritis in his right eye.DiagnosisBrolucizumab-related IOI in neovascular AMD refractory to aflibercept.InterventionsA combination therapy involving of intravitreal brolucizumab and STTA.OutcomesThe anti-vascular endothelial growth factor inhibitor was changed back to aflibercept; however, exudation persisted. Therefore, a combination therapy involving STTA (5 mg/0.5 mL) and intravitreal injection of brolucizumab (6.0 mg/0.05 mL) was performed to treat the exudation and as prophylaxis to recurrent IOI. Combination therapy achieved no recurrent IOI and resolution of exudation with 8-week treatment intervals.LessonsThis case might indicate that STTA is not only an optimal treatment option for brolucizumab-related IOI but also a preventive agent for this condition.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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