Tearing of the Retinal Pigment Epithelium after Intravitreal Injection of Brolucizumab

Purpose: To report tearing of the retinal pigment epithelium (RPE) that occurred after intravitreal injection of brolucizumab for polypoidal choroidal vasculopathy (PCV) with pigment epithelial detachment (PED).Case summary: A 68-year-old man presented to our clinic with a 1-week history of decreased visual acuity in the left eye. His best-corrected visual acuity (BCVA) was 0.2 in the left eye. Fundus photography and optical coherence tomography (OCT) re-vealed PED and subretinal fluid (SRF). PCV was diagnosed based on the fluorescein angiography finding of a nonspecific hy-perfluorescent lesion; indocyanine green angiography revealed a branching vascular network with a dilated polypoidal hyper -fluorescent lesion at the end. Thus, the patient underwent intravitreal injection of brolucizumab. At the 2-week follow-up, PED and SRF were both reduced but a tear was present in the RPE; the patient's visual acuity had not improved. After two further in-travitreal injections of brolucizumab, OCT showed decreases in SRF and PED; BCVA remained stable at 0.2 without improvement.Conclusions: Tearing of the RPE is a rare complication that can occur after intravitreal injection of current anti-vascular endothe-lial growth factor agents. Clinicians should carefully consider the potential for tearing of the RPE after intravitreal injection of brolucizumab.