Factors Affecting Disease Stability After Intravitreal Brolucizumab Injection in Refractory Neovascular Age-related Macular Degeneration

Abstract

Purpose : To investigate the factors affecting the treatment interval of brolucizumab in patients with neovascular age-related macular degeneration (nAMD) refractory to previous anti-vascular endothelial growth factor (VEGF).

Methods : We retrospectively analyzed the medical records of 31 eyes of 31 patients with nAMD that recurred repeatedly despite conventional anti-VEGF treatment and switched to brolucizumab. Divided into the Group 1 (extension of treatment interval (TE) <12weeks, N=16) and the Group 2 (TE ≥12weeks, N=15), best-corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters (central retinal subfield thickness (CRT), subfoveal choroidal thickness (SFCT), intraretinal fluid (IRF), subretinal fluid (SRF), sub-retinal pigment epithelial (RPE) fluid, macular volume (MV) and foveal volume (FV)) and choroidal vascularity index (CVI) were analyzed at 2, 4, 8 and 12 weeks, respectively. The morphological characteristics of choroidal neovascularization (CNV) including vessel analysis, fractal analysis and choriocapillaris flow deficit (CCFd) around CNV were assessed by OCT angiography (OCTA). Factors influencing the extension of the treatment interval to 12 weeks or more were analyzed using logistic regression analysis.

Results : The proportion of dry macula (absence of both SRF and IRF) of the Group 2 (60%) was significantly higher than that of the Group 1 (12.5%) at 2 weeks (P<0.05). There was no significant difference of BCVA and SFCT between the groups at all time-points. CST was significantly low in the group 2 compared to the group 1 at 2 (237.1μm vs. 280.8μm, P<0.05), 4 (224.0μm vs. 262.9μm, P<0.05) and 8 weeks (216.8μm vs. 331.1μm, P<0.05), respectively. Group 2 had less CNV area (0.63mm² vs. 1.27mm², P<0.05) and total vessel length (0.22mm vs. 0.42mm, P<0.05) compared to the Group 1. CCFd was significantly lower in the Group 2 than in Group 1 (42.7% vs. 48.2%, P<0.05). The dry macula state at 2 weeks (Odds ratio (OR) = 8.3, P<0.05) and the lower CCFd (OR=0.73, P<0.05) were factors influencing the TE more than 12weeks.

Conclusions : Early complete remission after brolucizumab switching and choriocapillary function around CNV can be considered as one of the prognostic factor for long-term treatment response in nAMD refractory to other anti-VEGFs.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.