Reducing risk of brolucizumab-related intraocular inflammation

Postmortem pathological examinations, animal studies, and anecdotal reports suggest that coronavirus disease 2019 (COVID-19) could potentially affect intraocular tissue. However, published evidence is scarce and conflicting. In our study, we screened 100 eyes of 50 patients hospitalized for COVID-19. Relevant medical and ophthalmological history was assessed as well as symptoms, laboratory results, specific treatments, clinical course, and outcome. Ophthalmic exams including assessment of best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, ocular motility, ophthalmoscopy as well as optical coherence tomography (OCT) of the macula and the optic disc was performed at hospital admission and 29 to 192 days later. Of the 50 patients included, 14 (28%) were female. Median age was 64.5 (range 29–90) years. COVID-19 severity was mild in 15 (30%), severe in 30 (60%), and critical in five cases (10%). At baseline, median BCVA was 0.1 (0–1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) and median IOP was 16 (8–22) mmHg. At follow-up, no relevant changes in BCVA and IOP were documented. No signs of active intraocular inflammation or optic nerve affection were found and OCT findings were widely stable during the observation period. Our findings suggest that COVID-19 does not regularly affect intraocular tissue.

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Postprocedural Endophthalmitis or Postprocedural Intraocular Inflammation: A Diagnostic Conundrum

Case Reports in Ophthalmology ◽

10.1159/000511970 ◽

2021 ◽

pp. 418-424

Author(s):

Aisha Al Busaidi ◽

Ahmed Al-Hinai

Keyword(s):

Pars Plana Vitrectomy ◽

Povidone Iodine ◽

Complete Recovery ◽

Neovascular Glaucoma ◽

Intraocular Inflammation ◽

Aqueous Samples ◽

Patient Counseling ◽

Pars Plana ◽

Culture Negative ◽

Office Procedures

We experienced an atypical endophthalmitis occurring post consecutively performed in-office procedures; an intravitreal injection (IVI) of ranibizumab followed by an anterior chamber (AC) paracentesis performed twice in an eye with neovascular glaucoma (NVG). A 52-year-old diabetic male who was asymptomatic developed signs of endophthalmitis and decreased vision without pain in his left eye a few days post-IVI and AC paracentesis. The condition worsened after an initial vitreous tap and injection of antibiotics. Cultures of vitreous and aqueous samples were negative. Complete resolution occurred after a pars plana vitrectomy with IVI of antibiotics and steroid with removal of a dense “yellowish-brown” fibrinous plaque. The absence of pain, presence of a peculiar colored fibrin, mild-to-moderate vitritis without retinitis, negative cultures, and complete recovery despite the fulminant presentation; favor a diagnosis of inflammation over infection. We hypothesize that a micro-leak from a 26-gauge AC tap tract might have served as an entry port for 5% povidone-iodine from the ocular surface thus inciting inflammation. However, an exuberant inflammatory response that can be typically seen in NVG eyes after intraocular procedures cannot be excluded. Various causes of inflammation post-procedures, both toxic and nontoxic should be considered in atypical culture-negative fulminant endophthalmitis cases with good outcome posttreatment. Any minor ocular procedure may carry a risk of such complication. Patient counseling and care must be exercised in performing these procedures.

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Severe Hypotony-induced Intraocular Inflammation after Removal of Ripcord Suture from a Glaucoma Drainage Device in Uveitis Patient

Ocular Immunology and Inflammation ◽

10.1080/09273948.2021.1903936 ◽

2021 ◽

pp. 1-3

Author(s):

Ilaria Testi ◽

Peter Addison ◽

Winifred Nolan ◽

Carlos Pavesio

Keyword(s):

Intraocular Inflammation ◽

Glaucoma Drainage Device ◽

Drainage Device

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Three Japanese cases of intraocular inflammation after intravitreal brolucizumab injections in one clinic

Japanese Journal of Ophthalmology ◽

10.1007/s10384-021-00819-7 ◽

2021 ◽

Author(s):

Taiichi Hikichi

Keyword(s):

Intraocular Inflammation

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Neoplasia and intraocular inflammation: From masquerade syndromes to immunotherapy-induced uveitis

Progress in Retinal and Eye Research ◽

10.1016/j.preteyeres.2019.05.002 ◽

2019 ◽

Vol 72 ◽

pp. 100761 ◽

Cited By ~ 5

Author(s):

Sara Touhami ◽

Isabelle Audo ◽

Céline Terrada ◽

Alain Gaudric ◽

Phuc LeHoang ◽

...

Keyword(s):

Intraocular Inflammation ◽

Masquerade Syndromes

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Heavy Silicone Oil and Intraocular Inflammation

BioMed Research International ◽

10.1155/2014/574825 ◽

2014 ◽

Vol 2014 ◽

pp. 1-16 ◽

Cited By ~ 16

Author(s):

Francesco Morescalchi ◽

Ciro Costagliola ◽

Sarah Duse ◽

Elena Gambicorti ◽

Barbara Parolini ◽

...

Keyword(s):

Specific Gravity ◽

Molecular Mechanisms ◽

Silicone Oil ◽

Surgical Techniques ◽

Chemical Properties ◽

Intraocular Inflammation ◽

Retinal Breaks ◽

Oxane Hd ◽

Long Acting ◽

Physical And Chemical

In the past two decades, many advances have been made in vitrectomy instrumentation, surgical techniques, and the use of different tamponade agents. These agents serve close retinal breaks, confine eventual retinal redetachment, and prevent proliferative vitreoretinopathy (PVR). Long-acting gases and silicone oil are effective internal tamponade agents; however, because their specific gravity is lower than that of the vitreous fluid, they may provide adequate support for the superior retina but lack efficacy for the inferior retina, especially when the fill is subtotal. Thus, a specific role may exist for an internal tamponade agent with a higher specific gravity, such as heavy silicone oils (HSOs), Densiron 68, Oxane HD, HWS 45-300, HWS 46-3000, and HeavySil. Some clinical evidence seems to presume that heavy tamponades are more prone to intraocular inflammation than standard silicone if they remain in the eye for several months. In this review, we discuss the fundamental clinical and biochemical/molecular mechanisms involved in the inflammatory response after the use of heavy tamponade: toxicity due to impurities or instability of the agent, direct toxicity and immunogenicity, oil emulsification, and mechanical injury due to gravity. The physical and chemical properties of various HSOs and their efficacy and safety profiles are also described.

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