The State of the Blood–Aqeous Barrier During Anti-Angiogenic Therapy in Patients with Exudative Age-Related Macular Degeneration

Purpose: To evaluate the status of the blood–aqueous barrier by objectively measuring protein concentration in the aqueous humor using laser flare photometry (LFP) in patients with exudative age-related macular degeneration (AMD) undergoing anti-angiogenic therapy. Materials and Methods: This prospective, comparative, interventional, randomized, single-center, pilot study included 30 naïve patients (33 eyes) with exudative AMD. All patients were randomly assigned to two groups. The first group (15 patients (17 eyes)) was administered intravitreal injections of 2 mg (0.05 mL) aflibercept, while the second group (15 patients (16 eyes)) received 6 mg (0.05 mL) brolucizumab. The regimen of treatment in both groups was treat-and-extend (T&E). Results. The median laser flare photometry score before treatment in the aflibercept group was 6.4 (4.3; 10.8) ph/ms, and after 6 months it was 5.1 (3.9; 6.9) ph/ms, p=0.018. In the brolucizumab group, the median laser photometry score was 7.0 (6.0; 9.8) ph/ms, and after 6 months it was 5.7 (5.0; 9.1) ph/ms, p=0.01. During the follow-up period, no significant changes in the median LFP were noted in either group. The median LFP score at baseline and at 6 months did not differ significantly between the groups (p=0.31 and p=0.33, respectively). Conclusions: Over the 6-month follow-up, treatment with aflibercept or brolucizumab using a T&E regimen in naïve patients with nAMD was not associated with an increase in LFP values. Trial registration: The trial registration number is NCT07375901 (January 22, 2026). Retrospectively registered.