Authors’ response: “Brolucizumab-associated intraocular inflammation in Indian patients by VRSI study group”

Dear Editor,

Thank you for showing interest in our article titled “Brolucizumab-associated intraocular inflammation in Indian patients by VRSI Study Group.”[1] We appreciate the keen observations made by the authors in our manuscript. However, we would like to clarify the following:

The images have been borrowed from the previous publication by Chakraborty et al.,[2] who is a co-author in the present study and after due permission was taken from the corresponding author. A source note has been inserted along with the legends for every image in the current article.

Three centers out of those which contributed to the previous study are a part of the current study, and thus, the number of the cases is lesser than that reported in the previous study. There may be an overlap of a few cases which were reported in the same time duration, with additional cases taken from these centers, which had been reported till January 2023. However, the cases can surely be contributed from a small case series from the eastern part of India to be a part of a larger multicentric study with a bigger dataset from all parts of the country.

In the previous study by Chakraborty et al., there were a total of five contributing centers.[2] However, only three out of five were included in the current study. The median interval between brolucizumab injections reported as 6 weeks in the previous publication was based on the dataset from all five centers. However, the three centers which contributed to this study had patients treated with pro re nata (PRN) dosing and 8 weeks interval between brolucizumab injections.

We thank the authors for their valid suggestion to have a comparative analysis between the cases that developed Intraocular inflammation (IOI) after the first brolucizumab injection (n = 12) and those that developed IOI after subsequent injections (n = 9). Such an analysis could surely reveal meaningful trends, and we will surely consider working on this.

Vitreo-Retinal society- India (VRSI) does have a safety committee in place. However, it is at the discretion of the treating physician to report an adverse drug event to the committee or not. Thus, it would be wrong to say that every event is reported to the VRSI safety committee. The VRSI study group shares the study idea with the members of the society, and those who respond and are agreeable to share the data are included in the study.

The article has undergone a peer review process by the esteemed journal, and it would be inappropriate to raise a question on the methodology used for data collection and the statistical analysis done.

This was a retrospective study, and we have collected the data from the participating sites and analyzed them. The decision to treat the patients with a repeat injection of brolucizumab despite a history of IOI was at the discretion of the treating physician. We are still learning about anti-vascular endothelial growth factor–induced uveitis and do not know if it may recur if the same agent is reused.

This is a real-world data and surely may add to our knowledge of using this drug for our patients. This study is surely not proposing any treatment guidelines based on the data used, which was retrospective and small. An appropriate prospective multicentric study in future may answer some of the questions raised by the authors and provide guidelines for the use of this drug in our patients.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.