Short-term outcomes following treatment of recalcitrant cystoid macular edema secondary to radiation maculopathy using intravitreal brolucizumab

Abstract

Purpose To assess the efficacy of intravitreal brolucizumab (Beovu®, Novartis Pharmaceuticals) in a case of recalcitrant cystoid macular edema associated with radiation maculopathy secondary to retinoblastoma which was suboptimally responsive to other intravitreal anti-vascular endothelial growth factor (VEGF) therapies. Observations A 42-year old patient with a history of radiation maculopathy complicated by cystoid macular edema after chemoreduction treatment and radiation therapy for retinoblastoma was treated with intravitreal brolucizumab. Best-corrected visual acuity and central macular thickness assessed by optical coherence tomography were used to assess the clinical outcomes. The treated eye was also assessed for evidence of intraocular inflammation following injection. Cystoid macular edema showed marked reduction and near resolution two weeks after injection and improvement in best-corrected visual acuity which was maintained for 2 months of follow-up. No ocular inflammatory reactions or other adverse events were reported. Conclusions and Importance This case of radiation maculopathy refractory to other intravitreal anti-VEGF treatments showed good treatment response to brolucizumab therapy.

Brolucizumab for the Treatment of Degenerative Macular Conditions: A Review of Clinical Studies

“…A single injection of the drug led to visual gain and remarkable macular thickness reduction with minimal residual fluid that lasted for 8 weeks. 77 …”

“…A single injection of the drug led to visual gain and remarkable macular thickness reduction with minimal residual fluid that lasted for 8 weeks. 77 Murray et al studied the off-label use of intravitreal brolucizumab as a rescue therapy in a series of eyes with vision compromising macular oedema (MO) secondary to different ocular conditions, which had not responded to prior repetitive anti-VEGF or steroid treatment. 78 Analysis showed significant reduction of MO as well as marked BCVA improvement for all study participants following brolucizumab administration.…”

“…19,20 No signs of IOI or vasculitis were observed after treatment with brolucizumab in cases of advanced Coats' disease and radiation maculopathy. 76,77 Further long-term prospective studies are required in order to address the efficacy and safety of brolucizumab for these conditions.…”

Radiation Retinopathy: Detection and Management Strategies

“…Thus, prior treatment with anti-VEGF agents seems to have a better outcome than using IVTA in treatment-naive eyes. Isolated case reports on the use of aflibercept 90 and brolucizumab 91 in recalcitrant edema have also been recently published. Intravitreal dexamethasone implant is another effective treatment option, although Seibel et al demonstrated no difference in VA or central foveal thickness when comparing it with intravitreal bevacizumab and IVTA.…”