背景:报告1例视网膜中央动脉阻塞(CRAO),在玻璃体内注射布罗珠单抗治疗初治新生血管性年龄相关性黄斑变性(nAMD)患者后,无共同心血管疾病史。
方法:一名79岁的亚洲男性,没有心血管疾病史,如糖尿病或高血压,每月连续3次玻璃体内注射布卢珠单抗,用于治疗左眼进展性nAMD。第三次注射两天后,患者出现急性无痛性视力丧失。在眼底照片上观察到典型的具有樱桃红色斑点的视网膜白化,在光学相干断层扫描(OCT)扫描中也发现了具有高反射率的视网膜肿胀.在荧光素眼底血管造影术上,臂至视网膜时间和动静脉通过时间明显延迟,但未观察到提示眼内炎症(IOI)的临床发现。因此,CRAO被诊断出来,并立即进行前房穿刺。然而,在三个月的随访期间,视力没有改善,尽管长期口服类固醇和抗血小板药物。
结论:在极少数情况下,没有心血管合并症的患者在玻璃体内注射布卢珠单抗后可发生CRAO,而没有IOI的确证.因此,对于老年nAMD患者,玻璃体内注射布卢珠单抗后,应始终考虑CRAO,需要仔细观察。即使患者没有任何其他心血管疾病史。
BACKGROUND: To report a
case of central retinal artery occlusion (CRAO) after intravitreal injection of brolucizumab for a treatment-naïve neovascular age-related macular degeneration (nAMD) patient without comorbid cardiovascular disease history.
METHODS: A 79-year-old Asian male without a cardiovascular disease history such as diabetes or hypertension underwent three times of monthly consecutive intravitreal brolucizumab injections for treatment of progressed nAMD in his left eye. Two days after the third injection, the patient presented with acute painless visual loss. Typical retinal whitening with a cherry red spot was observed on the fundus photograph, and retinal swelling with hyper-reflectivity was also identified on the optical coherence tomography (OCT) scan. On the fundus fluorescein angiography, arm-to-retina time and arteriovenous transit time were remarkedly delayed, but clinical findings suggesting an intraocular inflammation (IOI) were not observed. Therefore, CRAO was diagnosed, and anterior chamber paracentesis was administrated immediately. However, there had been no improvement in visual acuity during the follow-up period of three months, despite prolonged oral steroid and anti-platelet agent medication.
CONCLUSIONS: In rare cases, patients without cardiovascular comorbidities can develop CRAO after intravitreal brolucizumab injection without gross evidence of IOI. Therefore, CRAO should always be in consideration and careful observation is required after intravitreal brolucizumab injection for nAMD patients with old age, even if the patient does not have any other cardiovascular disease history.