Bilateral effect following off label unilateral intravitreal brolucizumab injection in patient with pseudophakic cystoid macular edema

To report a bilateral reduction in pseudophakic cystoid macular edema (PCME) after unilateral intravitreal injection (IVI) of brolucizumab.

A 64-year-old female with bilateral recalcitrant PCME was treated with one dose of intravitreal ozurdex implant and triamcinolone acetonide each in both the eyes, with an equivocal response. On switching to IVI brolucizumab in the right eye (OD), the patient showed significant improvement in the best-corrected visual acuity (BCVA) with a notable reduction in the intraretinal fluid (IRF) and central subfield thickness (CST) in both the eyes at one month.

In conclusion, IVI brolucizumab is effective for the management of recalcitrant PCME with good visual and anatomical outcomes at one month. However, this molecule can also have therapeutic efficacy in the uninjected eye possibly due to systemic escape. More research into the pharmacokinetic properties of this novel molecule is needed to validate our findings.