습성 연령관련황반변성에서 유리체강 내 브롤루시주맙 주입술의 단기 결과 분석 = Short-term Effect and Safety of a Single Intravitreal Brolucizumab in Refractory Neovascular Age-related Macular Degeneration

다국어 초록 (Multilingual Abstract)

Purpose: To assess effect of brolucizumab in Korean patients, and also analyze incidence of intraocular inflammation (IOI) rate, clinical features, treatment and prognosis.
Methods: We reviewed EMR chart of history of brolucizumab injection patients retrospectively in Severance Hospital. Total 101 eyes of 92 patients were included. Patients consist of 80 wet age-related macular degeneration (wAMD) and 21 polypoidal choroidal vasculopathy (PCV). Demographic data, best corrected visual acuity (BCVA), anatomical features as central macular thickness, subretinal fluid (SRF), intraretinal fluid (IRF), height of pigment epithelium detachment (PED) through optical coherence tomography, incidence of IOI and their clinical feature, treatment, prognosis were assessed.
Results: BCVA and subfoveal choroidal thickness of patients showed no statistical significancy. Central macular thickness, IRF and PED height showed statistically significant effect in 1 month after injection. SRF was improved significantly during 2 months of follow up. In subgroup analysis of PCV group, BCVA, subfoveal choroidal thickness, IRF showed no statistical significance. Central macular thickness and SRF showed improvement throughout 2 months. PED height showed 1 month of statistically significant effectiveness. There were six cases (5.9%) of IOI in total 101 eyes of brolucizumab injection cases. One case (0.99%) among IOI patients showed non-occlusive vasculitis.
There was no case of occlusive vasculitis in our study. All cases were resolved after steroid treatment, topical or combination of topical and subtenon injection.
Conclusions: Intravitreal injection of brolucizumab in Korean wAMD patients and PCV subgroups refractory to other anti-VEGF showed effectiveness in central macular thickness, IRF, SRF, and PED height. Incidence of IOI was 5.9% and no case of severe visual acuity deterioration.
All IOI cases were resolved after topical or subtenon triamcinolone injection.

국문 초록 (Abstract)

목적: 한국인 습성 연령관련황반변성 환자들에서 브롤루시주맙의 효과를 분석하고, 안내 염증의 빈도 및 양상, 치료, 예후를 알아보고자 하였다.
대상과 방법: 단일 의료기관에서 92명의 환자의 101안(80안의 습성 연령관련황반변성 및 21안의 결절 맥락막혈관병증)에 대하여 후향적으로 의무기록을 분석하였다. 인구학적 정보, 주사 전후의 최대교정시력, 빛간섭단층촬영으로 얻어진 망막하액, 망막내액의 여부 및망막색소상피박리의 높이 변화, 안내 염증의 빈도, 임상 양상, 치료, 예후에 대하여 분석하였다.
결과: 주사 전후 최대교정시력 및 황반하맥락막두께는 통계적 유의성을 보이지 않았다. 중심황반두께, 망막내액, 망막색소상피박리의높이는 주사 후 1달간, 망막하액은 2개월간 유의한 감소가 있었다. 결절맥락막혈관병증 환자를 소그룹 분석하였을 때 최대교정시력, 황반하 맥락막두께, 망막내액은 통계적 유의성을 보이지 않았으며 망막색소상피박리 높이는 주사 후 1개월간, 중심황반두께 및 망막하액은 2개월간 유의한 감소가 있었다. 6개의 안내 염증 증례가 있었으며(5.9%) 1개의 증례에서 비폐쇄성 혈관염이 발생하였다. 모든 증례는 스테로이드 안약 및 테논낭하 주사 술 후 호전되었다.
결론: 기존 치료에 반응이 부족한 습성 연령관련황반변성에서 브롤루시주맙 주사는 중심망막두께, 망막내액, 망막하액, 망막색소상피박리 높이의 유의한 감소를 보였다. 안내 염증의 빈도는 5.9%이고 심각한 시력저하는 발생하지 않았으며 스테로이드 안약 및 테논낭하주사 술 후 호전되었다.

참고문헌 (Reference)

• 1 Kataoka K, "Three cases of brolucizumab-associated retinal vasculitis treated with systemic and local steroid therapy" 65 : 199-207, 2021
• 2 Shigemoto Y, "The combination therapy of subtenon triamcinolone acetonide injection and intravitreal brolucizumab for brolucizumab-related intraocular inflammation" 100 : e27580-, 2021
• 3 Khanani AM, "Safety outcomes of brolucizumab in neovascular age-related macular degeneration : results from the IRIS registry and Komodo healthcare map" 140 : 20-28, 2022
• 4 Monés J, "Risk of inflammation, retinal vasculitis, and retinal occlusion-related events with brolucizumab:post hoc review of HAWK and HARRIER" 128 : 1050-1059, 2021
• 5 Haug SJ, "Retinal arterial occlusive vasculitis following intravitreal brolucizumab administration" 18 : 100680-, 2020
• 6 Brown DM, "Ranibizumab versus verteporfin for neovascular age-related macular degeneration" 355 : 1432-1444, 2006
• 7 Nguyen HV, "Ocular adverse events following intravitreal brolucizumab for neovascular age-related macular degeneration at a single tertiary care center" 32 : 2747-2751, 2022
• 8 Witkin AJ, "Occlusive retinal vasculitis following intravitreal brolucizumab" 4 : 269-279, 2020
• 9 Anderson WJ, "Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs : a narrative review" 7 : 37-, 2021
• 10 Heier JS, "Intravitreal aflibercept(VEGF trap-eye)in wet age-related macular degeneration" 119 : 2537-2548, 2012
• 11 Dugel PU, "HAWK and HARRIER : ninetysix-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration" 128 : 89-99, 2021
• 12 Ogura Y, "Efficacy and safety of brolucizumab versus aflibercept in eyes with polypoidal choroidal vasculopathy in Japanese participants of HAWK" 106 : 994-999, 2022
• 13 Chakraborty D, "Brolucizumab in neovascular age-related macular degeneration-Indian real-world experience : the BRAILLE study" 15 : 3787-3795, 2021
• 14 Markham A, "Brolucizumab : first approval" 79 : 1997-2000, 2019
• 15 Nguyen QD, "Brolucizumab : evolution through preclinical and clinical studies and the implications for the management of neovascular age-related macular degeneration" 127 : 963-976, 2020
• 16 Ferris FL 3rd, "Age-related macular degeneration and blindness due to neovascular maculopathy" 102 : 1640-1642, 1984