Short Term Outcomes of Switching to Brolucizumab for Neovascular Age-related Macular Degeneration Limited Response to Aflibercept

Purpose: To evaluate clinical outcomes of brolucizumab injection in neovascular age-related macular degeneration (nAMD) that shows limited response to aflibercept therapy.Methods: Retrospective review of medical records was performed for patients diagnosed with nAMD who underwent switching to brolucizumab due to limited response to aflibercept. Visual acuity (VA) and central retinal thickness (CRT) were compared between before switching, 1 month and 3 months after the switching. The proportion of patients exhibiting subretinal fluid (SRF) and intraretinal fluid (IRF) were identified. Development of intraocular inflammation was additionally evaluated.Results: Thirteen patients were included. The mean VA and CRT was 0.38 ± 0.20 and 379.7 ± 100.9 µm before the switching, 0.34 ± 0.19 and 262.2 ± 94.3 µm at 1 month, and 0.39 ± 0.24 and 322.9 ± 92.8 µm at 3 months. There was a significant decrease in CRT at 1 month after the switching (p = 0.003). However, VA changes were not significant. The proportion of patients showing SRF and IRF was 100% and 23.1% before the switching, 30.8% and 7.7% at 1 month, and 69.2% and 30.8% at 3 months. Retinal vasculitis developed in one patient (7.7%). The inflammation was resolved after steroid treatment.Conclusions: Despite the inherent limitations posed by the small sample size, this study represents the first domestic report evaluating the outcomes of switching to brolucizumab. Brolucizumab injection was found to be a useful alternative treatment for short-term resolution of retinal edema in nAMD showing limited response to aflibercept. However, the risk of intraocular inflammation should be considered.