Brolucizumab for recalcitrant macular neovascularization in age-related macular degeneration with pigment epithelial detachment

Purpose: To analyze anatomic and functional response to intravitreal brolucizumab in age-related macular degeneration recalcitrant to previous intravitreal anti-VEGF therapies. Methods: In this monocentric, one arm, retrospective study, eyes affected by neovascular age-related macular degeneration (nAMD) resistant to other intravitreally injected anti-vascular endothelial growth factor inhibitors were switched to intravitreal brolucizumab. All patients underwent ophthalmological examinations at baseline and in regular follow-up intervals. Best registered visual acuity (BRVA), Goldmann tonometry, intraocular pressure (IOP), central retinal thickness (CRT) and pigment epithelial detachment (PED) characteristics were analyzed at initiation of anti-VEGF treatment, at treatment switch, and at the end of brolucizumab loading phase. Results: The study included 20 eyes of 18 consecutively treated patients (age: 77 +/- 6 years). All eyes had macular neo-vascularization with PED. Previous treatments included intravitreal aflibercept, bevacizumab, and ranibizumab and had not resulted in a significant improvement in BRVA (0.5 +/- 0.5 logMAR vs 0.5 +/- 0.6 logMAR) or mean CRT (320 +/- 60 mu m vs 313 +/- 83 mu m) up to treatment switch to brolucizumab. At the end of the brolucizumab loading phase, there was significant improvement for both BRVA (0.3 +/- 0.2 logMAR, P < 0.05) and CRT (264 +/- 55 mu m, P < 0.05). Under previous antiVEGF therapy, there was a significant increase/deterioration in both PED area (2.68 mm(2) to 5.18 mm(2), P < 0.05) and PED volume (0.39 mm3 to 1.07 mm3, P < 0.05); however, both parameters improved after switching to brolucizumab (3.81 mm(2) and 0.37 mm(3), P < 0.05). Conclusion: Our results suggest a favourable anatomical and visual response after treatment switch to brolucizumab in patients with nAMD refractory to previous anti-VEGF agents.