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Context: Concerns about brolucizumab’s (Pagenax®) association with intraocular inflammation (IOI) limit its use despite its cost-effectiveness and efficacy. This multicentric study analyzes IOI incidence across 21 tertiary eyecare centers in India since its introduction in October 2020. Purpose: To determine the real-world incidence rate of IOI in Indian patients secondary to intravitreal brolucizumab across 21 tertiary eye care centers in India. Settings and Design: Retrospective multicentric, survey-based study. Methods: Data including number of patients treated, clinical indications, side effects encountered, and IOI case details was collected via Google Forms in 21 Indian tertiary eye care centers since October 2020. Mean, median, frequency, and standard deviation were calculated for statistical analysis. Results: All centers used pro re nata protocol for brolucizumab injections with a minimum injection interval of 8 weeks. The incidence of IOI was 0.79% (21 events out of 2655 eyes). Treatment indications included idiopathic polypoidal choroidal vasculopathy, neovascular age-related macular degeneration, diabetic macular edema, and off-label uses. IOI was experienced after the first injection (57%) in majority of cases with a median onset of 14 days (range: 1–65 days). IOI was mild in 28.5%, moderate in 33%, and severe in 38% of cases. Eighteen out of 21 IOI eyes recovered preinjection best corrected visual acuity or better. Conclusions: Our study found a lower IOI incidence (0.79%) with brolucizumab (Pagenax) in Indian patients compared to previously reported literature. IOI events were mostly mild to moderate, and post-treatment, most patients improved or maintained BCVA. Larger prospective multicentric studies with PRN dosing protocol are needed to confirm these findings.

Purpose: This study aimed at psychiatric evaluation of patients with central serous chorioretinopathy (CSCR) and its association. Material: Consecutive patients diagnosed to have CSCR were included in the study. The participants underwent a routine eye examination. After informed consent, participants were subjected to psychiatric evaluation by a qualified psychiatrist. Details of evaluation and psychiatric disorders were documented and if treatment required were given by the psychiatrist. The outcome measure was the incidence of psychological disorder. Results: Cross-sectional observational data analysis of 40 patients diagnosed to have treatment-naive CSCR who agreed to undergo psychiatric evaluation were included in the study. The ethnic origin of the patients was Asian Indian. The mean age was 39.55 ± 8.33 years with a male to female ratio of 33:7. After a thorough psychiatric evaluation, 31 individuals (77.5%) diagnosed to have mixed anxiety disorders, 4 (10%) had the major depressive disorder, and 5 (12.5%) had adjustment disorder. All 40 patients had stressed personality. All 40 patients had treatment with anti-anxiolytics and advised lifestyle modification. Of these 40 patients, one patient (2.5%) underwent treatment additionally with an antidepressant. Conclusion: All patients with acute CSCR had some form of psychiatric disorder. Psychiatric evaluation in acute treatment naïve CSCR may contribute to the management besides other factors known in the management.

Context: Concerns about brolucizumab's (Pagenax®) association with intraocular inflammation (IOI) limit its use despite its cost-effectiveness and efficacy. This multicentric study analyzes IOI incidence across 21 tertiary eyecare centers in India since its introduction in October 2020. Purpose: To determine the real-world incidence rate of IOI in Indian patients secondary to intravitreal brolucizumab across 21 tertiary eye care centers in India. Settings and Design: Retrospective multicentric, survey-based study. Methods: Data including number of patients treated, clinical indications, side effects encountered, and IOI case details was collected via Google Forms in 21 Indian tertiary eye care centers since October 2020. Mean, median, frequency, and standard deviation were calculated for statistical analysis. Results: All centers used pro re nata protocol for brolucizumab injections with a minimum injection interval of 8 weeks. The incidence of IOI was 0.79% (21 events out of 2655 eyes). Treatment indications included idiopathic polypoidal choroidal vasculopathy, neovascular age-related macular degeneration, diabetic macular edema, and off-label uses. IOI was experienced after the first injection (57%) in majority of cases with a median onset of 14 days (range: 1–65 days). IOI was mild in 28.5%, moderate in 33%, and severe in 38% of cases. Eighteen out of 21 IOI eyes recovered preinjection best corrected visual acuity or better. Conclusions: Our study found a lower IOI incidence (0.79%) with brolucizumab (Pagenax) in Indian patients compared to previously reported literature. IOI events were mostly mild to moderate, and post-treatment, most patients improved or maintained BCVA. Larger prospective multicentric studies with PRN dosing protocol are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

An immunocompetent, 25-year-old gentleman with bilateral chronic uveitis presented to various uveitis clinics at different points of time with documented typical clinical features of Toxoplasma Chorioretinitis (Headlight in fog appearance), Behcet's Disease (Hypopyon with peripheral retinal vasculitis), and Presumed Ocular Tuberculosis (Granulomatous Intermediate Uveitis with positive Interferon-gamma release assay) and had been treated with anti-toxoplasma drugs, oral prednisolone, and immunomodulation with oral Mycophenolate/oral Azathioprine to no avail. After cytological examination of vitreous aspirate, he was found to have non-Langerhans cell Histiocytosis which responded to chemotherapy with Vinblastine and Cyclophosphamide.

The letter published in the Indian Journal of Ophthalmology discusses the use of anxiolytic therapy for central serous chorioretinopathy (CSCR) patients experiencing anxiety and depression. A double-blind prospective trial conducted on 50 CSCR patients revealed that a significant portion suffered from anxiety spectrum disorders, adjustment disorders, and major depressive disorders. Treatment with benzodiazepines or selective serotonin uptake inhibitors showed rapid resolution of CSCR symptoms. The study also highlighted the association between psychiatric morbidity, stress levels, and the severity of CSCR, emphasizing the importance of mental health in managing the condition. [Extracted from the article]