Brolucizumab for Treating Recalcitrant Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Purpose To report the anatomical and functional outcomes after switching to brolucizumab in patients with recalcitrant neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). Methods This retrospective case series assessed the impact of switching to brolucizumab on disease activity over 12 months in patients with recalcitrant nAMD and PCV. The data are presented as mean ± SD. Results Of the 27 eyes, 16 (59.3%) presented with recalcitrant nAMD and 11 (40.7%) presented with PCV. Patients with nAMD were older (81.4 ± 5.7 vs. 74.7 ± 7.7 years; p = 0.016 ) and had less fluid (central retinal thickness: nAMD: 349.3 ± 95.3 µm, PCV: 597.1 ± 348.4 µm; p = 0.005 ), which was explained by different pigment epithelial detachment heights (nAMD: 176.5 ± 102.6 µm, PCV: 384.6 ± 284.6 µm; p = 0.023 ). Twelve months after switching to bro (159 injections), the treatment interval increased from 5.6 ± 1.8 to 10.5 ± 4.5 weeks ( p = 0.01 ). Visual gains after switch were maintained in two out of three patients with intraocular inflammation (IOI). Conclusions PCV is remarkably overrepresented in the group of eyes with recalcitrant nAMD. Despite the risk of IOI, the strong drying potential of brolucizumab justifies its use in eyes requiring anti-VEGF treatment intervals of six weeks or less.