Early fluid-free macula and stability assessment: real world experience with Brolucizumab

Abstract Purpose: Brolucizumab is the most recent anti-vascular endothelial growth factor (anti-VEGF) agent commercialized, approved for neovascular age-related macular degeneration (nAMD) as the first indication. A fluid-free retina and no recurrence of fluids are the new targets of retinal therapy, and early clinical experience with Brolucizumab shows strong effectiveness in drying retinal fluid. This study presents the results of real-world experience in treating nAMD naïve patients with intravitreal Brolucizumab. Methods: This prospective observational study included 28 treatment-naïve eyes from two centres who underwent therapy with intravitreal injection of Brolucizumab for age-related neovascular macular degeneration. Several parameters were evaluated, including central retinal thickness (CRT), central retinal volume (CRV), intraretinal fluid (IRF), subretinal fluid (SRF), detachment of pigment retinal epithelium (PED), and subretinal hyper-reflective material (HRSM), from baseline up to 16 weeks. Results: CTR and CRV reduced in a significant manner at w16 (p<0.0001 and p=0.01 respectively). SRF, IRF, PED, and HRSM almost disappeared in most cases. At w16, resolution of clinical activity was assessed at 86% to 89%, with PED showing a slower response. Interestingly, the cohort showed resolution of signs at w4 up to 82% of the eyes, after only one IVT-B. Visual acuity improved from 0.76 at baseline to 0.55 logMAR at w16 (p=0.002). Conclusion: Our report strongly associated the effectiveness of the three-monthly induction treatment with a quick resolution of fluids in nAMD patients treated with Brolucizumab.