Brolucizumab in patients with neovascular age-related macular degeneration: Real-life outcomes from a tertiary care eye hospital

Abstract

Purpose: To report real-world clinical evidence of brolucizumab in treating neovascular age-related macular degeneration (nAMD).

Methods: This study included 37 eyes with nAMD treated with intravitreal injections of brolucizumab. The main outcomes were best corrected visual acuity (BCVA) changes, central retinal thickness (CRT), and serious ocular adverse events. Intraretinal fluid (IRF) and subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci, macular atrophy, and retinal pigment epithelial tears were evaluated.

Results: The mean BCVA of all patients showed a post-treatment value of 0.47 ± 0.33 log of minimum angle of resolution (LogMAR), compared to a baseline measure of 0.50 ± 0.28 LogMAR ( P = 0.372). For treatment-naïve patients, a non-statistically significant improvement in BCVA was observed ( P = 0.116). Both treatment-naive patients and the entire patient cohort exhibited a statistically significant improvement in the mean CRT after injections. Majority of patients exhibited improvements in optical coherence tomography findings, specifically in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes experienced ocular adverse events in the form of intraocular inflammation.

Conclusion: Brolucizumab did not yield a substantial improvement in BCVA, but it exhibited efficacy in reducing CRT in the entire study population and treatment-naive patients with nAMD. Our study identified intraocular inflammation as a significant adverse event with brolucizumab. Thus, precise patient selection, education, and vigilant inflammation monitoring are crucial for patients undergoing this treatment.

Figure 1

(a) BCVA in LogMAR before and after brolucizumab (entire study cohort). (b-d) BCVA in LogMAR before and after brolucizumab (three patients ‘groups) BCVA = best corrected visual acuity, LogMAR = log of minimum angle of resolution

Figure 2

(a) CRT in micrometers before and after brolucizumab (entire study cohort). (b-d) CRT in micrometers before and after brolucizumab (three groups of patients) CRT = central retinal thickness

Figure 3

(a) Baseline SD-OCT scan of a nontreatment-naïve patient demonstrates macular subretinal fluid and pigment epithelial detachment. (b) A 6-month (after six Beovu injections) SD-OCT scan demonstrates a notable reduction in the size of the pigment epithelial detachment with the absence of residual macular fluid SD-OCT = Spectral domain optical coherence tomography

Figure 4

(a) Baseline SD-OCT scan of a nontreatment-naïve patient demonstrates macular subretinal fluid and small pigment epithelial detachment. (b) At 8 weeks after four Beovu injections, SD-OCT scan demonstrates a reduction in the size of the pigment epithelial detachment with the absence of residual macular fluid SD-OCT = Spectral domain optical coherence tomography