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Occlusive Retinal Vasculitis Following Intravitreal Brolucizumab
Open accessAbstract
Purpose: To analyze a case series of retinal vasculitis reported to the American Society of Retina Specialists (ASRS) following Food and Drug Administration approval of brolucizumab for treatment of neovascular age-related macular degeneration. Methods: The ASRS Research and Safety in Therapeutics Committee analyzed clinical and imaging characteristics from submitted reports of retinal vasculitis after brolucizumab. Results: Retinal vasculitis was reported in 26 eyes of 25 patients (22 [88%] female) after treatment with brolucizumab. Imaging studies were available for 24 of 26 eyes. Most cases (92%) were associated with intraocular inflammation, which presented at a mean of 25 days (range, 3-63 days) after the most recent brolucizumab injection. Mean visual acuity (VA) was 20/52 (range, 20/25-4/200) before the adverse event, 20/151 (range, 20/25-hand motion) at presentation of the adverse event, and 20/243 (range, 20/30-light perception) at last follow-up. Twelve eyes (46%) had a greater than 3-line decrease in VA at final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse. Analysis of retinal imaging identified vasculopathy that involved retinal arteries (91%), retinal veins (79%), and choroidal vessels (48%). Occlusive disease was apparent on imaging in 83% of eyes. Treatment approaches were varied. Conclusions: Retinal vasculitis has been identified in a series of eyes following brolucizumab. Although a few eyes in this series were asymptomatic or minimally symptomatic, some eyes had significant vision loss. A careful examination for signs of active inflammation prior to brolucizumab injection is recommended. Once vasculopathy is suspected, angiographic imaging may help define the spectrum of involvement. Optimal treatment strategies remain unknown.
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“Average time to presentation was 53 days after the last brolucizumab injection (range 8–137 days).”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“The largest study outside of the clinical trials to date evaluating retinal vasculitis after brolucizumab is a retrospective analysis of 26 eyes from 25 patients that were reported to the ASRS [37].”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“The average time to presentation in recent case series has ranged from 30 to 53 days after injection [37, 38].”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“The female predominance of brolucizumab-associated retinal vasculitis reported by Witkin et al. (22 of 25 patients were female) may point towards an auto-immune response, although no definitive correlation to auto-immune disease has been made [37].”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“Anterior chamber cell was present in 65% of eyes.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“Occlusive vasculitis was noted in 85% of eyes [37].”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“Patients had variable extent of retinal vasculitis, with involvement of retinal arteries, veins or choroidal vessels.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“Choroidal ischemia was noted in 10 of 21 eyes.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“At final follow up, mean final BCVA was 20/243 and 46% had a greater than 3-line decrease in visual acuity.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“Clinical presentation was variable, however 92% of eyes exhibited signs of either anterior inflammation and/or posterior inflammation.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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“This study showed that BCVA worsened from an average baseline of 20/52 to 20/151 at time of presentation.”
From Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review (2021) · cites this paper as [37]
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Venkatesh, R., Mishra, S. B., Mangla, R., Acharya, I., Chitturi, S. P., Krishna, S. M., Chhablani, J. K., & Prabhu, V. (2024) · Indian Journal of Ophthalmology - Case Reports · doi:10.4103/ijo.ijo_966_23
Toxicity related with brolucizumabPreprint
Campos, A., Tomás, R., Oliveira, N., Mota, C., Silva, S., & Sousa, J. P. C. (2024) · Research Square · doi:10.21203/rs.3.rs-4009861/v1
A Rare Case of Retinal Vasculitis in a Patient With Autoimmune Lymphoproliferative Syndrome
Edwards, C. M., & Nanda, T. (2024) · Ophthalmic surgery, lasers & imaging retina · doi:10.3928/23258160-20240805-02
Rakusiewicz, K., Jędrzejczak-Młodziejewska, J., Kanigowska, K., & Hautz, W. (2025) · Biomedicines · doi:10.3390/biomedicines13010148
Васкулиты зрительного нерва: обзор литературы
Юсупов, А. Ф., Каримова, М. Х., Махкамова, Д. К., & Мухиддинова, М. С. (2025) · Офтальмология Восточная Европа · doi:10.34883/pi.2025.15.2.024
Kee, T. E., Choi, H. G., Kim, K. L., Kim, Y., & Park, S. P. (2025) · Journal of the Korean Ophthalmological Society · doi:10.3341/jkos.2025.66.8.346
Трояновська, К., Kustryn, T., Nasinnyk, I., Zborovska, O., Дорохова, О. Е., Gorianova, I. S., & Korol, A. R. (2026) · Research Square · doi:10.21203/rs.3.rs-8626646/v1
Schneider, M., Turan, L., Arif, F., Bjerager, J., Klefter, O. N., Faber, C., Subhi, Y., & Hajari, J. N. (2026) · Acta Ophthalmologica · doi:10.1111/aos.70161
Current landscape of drug induced retinal vasculitis
Murugan, S. B., Thomas, A. A., Kene, R. D., Rajan, A., Kelgaonkar, A., Vedhanayagi, R., Somanath, A., Mahendradas, P., Gokulvasanth, D., & Majumder, P. D. (2026) · Journal of Ophthalmic Inflammation and Infection · doi:10.1186/s12348-026-00619-5
Nowosielski, Y., Erlacher, C., Maier, S., Rauchegger, T., Franchi, A., & Rehák, M. (2026) · Ophthalmology and Therapy · doi:10.1007/s40123-026-01468-0
Adoption patterns of anti-vascular endothelial growth factor therapies in retinal disease
Kozlov, M., Sadeghi, E., & Chhablani, J. K. (2026) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-026-07492-x
Immunogenicity of locally acting large molecule products: An overview
He, L., Ji, P., Golding, A., Ren, Y., Shukla, C. G., Boyd, W., Lloyd, R., & Sahajwalla, C. G. (2026) · The Journal of Clinical Pharmacology · doi:10.1002/jcph.70298
Andõ, R., Kato, A., Kimoto, K., Itotani, M., Hikichi, T., Watanabe, G., Sato, T., Matsuda, H., Shiose, S., Matsubara, H., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15218507
Metadata
- Authors
- Witkin, A. J., Hahn, P., Murray, T. G., Arevalo, J. F., Blinder, K. J., Choudhry, N., Emerson, G. G., Goldberg, R. A., Kim, S. J., Pearlman, J., Schneider, E. W., Tabandeh, H., & Wong, R. W.
- Affiliations
- Tufts Medical Center, Boston, MA, USA
- NJ Retina, Teaneck, NJ, USA
- Murray Ocular Oncology and Retina, Miami, FL, USA
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, MD, USA
- Retina Institute (US)
- Vitreous Retina Macula Specialists of Toronto, Toronto, ON, Canada
- The Retina Center (US)
- Bay Area Retina Associates (US)
- Vanderbilt University Medical Center (US)
- Retinal Consultants, Sacramento, CA, USA
- Tennessee Retina (US)
- Retina Vitreous Associates Medical Group (US)
- Austin Retina Associates, Austin, TX, USA
- Corresponding author
- Hahn, Paul
- ORCID
- Venue
- Journal of VitreoRetinal Diseases
- Publisher
- SAGE Publications
- Published
- 2020-07
- Volume
- 4
- Issue
- 4
- Pages
- 269-279
- ISSN
- 2474-1264 (ISSN-L)
- 2474-1272
- PMC
- PMC7418897
- OpenAlex
- W3040108021
- Cited by
- 183
- References
- 19
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 27 · 2023: 34 · 2022: 41 · 2021: 46 · 2020: 3
- FWCI
- 24.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of VitreoRetinal Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (EY027691)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Keywords
- brolucizumab, occlusive retinal vasculitis, neovascular age-related macular degeneration, intraocular inflammation, retinal vascular disease, vision loss, anti-VEGF therapy, drug safety
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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