OCCLUSIVE RETINAL VASCULITIS AFTER AFLIBERCEPT 8 mg INJECTION FOR WET MACULAR DEGENERATION

To describe a case of occlusive retinal vasculitis (ORV) after intravitreal aflibercept 8 mg injection for wet macular degeneration.

Retrospective, interventional case report.

A 72-year-old woman presented with classic ORV 11 days after intravitreal aflibercept 8 mg injection in her left eye for wet macular degeneration. Visual acuity declined from 20/30 to 20/400. Laboratory investigations including Gram stain and cultures of vitreous aspirate, studies for infectious and noninfectious uveitis and hypercoagulable state were all negative. Oral prednisone, sub-Tenon triamcinolone acetonide, intravitreal dexamethasone and antibiotic injections, and topical steroids resulted in visual and anatomic improvement. ORV recurred when prednisone was tapered to 10 mg/day and was controlled with additional sub-Tenon triamcinolone acetonide, oral solumedrol, and a 0.18 mg fluocinolone acetonide implant. Subsequently exudation from wet macular degeneration recurred and responded to intravitreal faricimab with recovery to 20/30.

ORV is a rare complication of some intravitreal anti-VEGF medications and infectious causes of endophthalmitis. It can be managed with aggressive steroid treatment for an excellent visual outcome in some cases, although the disease may be chronic or recurrent.