Bilateral Sterile Intraocular Inflammation Following Intravitreal Aflibercept 8 mg Injections: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is an interesting case report concerning a bilateral sterile intraocular inflammation following intravitreal Aflibercept 8 mg injections.

Overall, the case report is well-written and well-organized, with an Introduction section which properly provides information about the background of the topic.

Furthermore, the Discussion section is clear and properly analyzes the key mechanisms underlying this ocular manifestation, also making a comparison with the previous published literature, trying to provide an explanation to the adverse event.

I have just some questions and suggestions for the authors to improve the manuscript.

1) The authors should provide more information about the systemic condition of the patient: was the patient affected by systemic diseases, in particular by autoimmune and/or immunological diseases? The authors should provide this information in the case description.

2) Why the authors decided to use Aflibercept 8 mg considering that the patient has already shown adverse event to Aflibercept 2 mg? Why the authors decided not to switch to another intravitreal and different drug? The authors should specify this.

3) I suggest the authors to add OCT images to show nAMD of the patient.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The case is interesting , although the subject is now well recognized. Sterile inflammation is regularly reported post 8mg aflibercept injection.

Specific comments

1. Abstract – please make it clear that injection was bilateral .
2. Abstract – please define time of recovery
3. Line 35-36: please mention faricimab as well
4. Introcudction: please provide the numbers for incidence of IOI post intravtreal therapy. Make differentiation for sterile and infectious.
5. Case report:

• Lines 55-57 : please make it clear that treatment was for nAMD.
• Line 63-69 : was it possible to examine fundus ? Please make it clear
• Please describe pain sensation of the patient – was it present ? If not that also confirms your diagnosis. Please supply that info.
• OCT scans of the maculas post treatment would be informative.

6. Discussion:
   1. Bilateral 8mg injection of 8 mg aflibercept in the light of available data on IOI is controversial. Please comment on this.
   2. It is first bilateral case , bacause the injection was bilateral ; please soften the tone
   3. Lines 132-133 – and absence of pain

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Good job on revision. Regards.