Structural and vascular features in non-responder neovascular age-related macular degeneration after Brolucizumab injection: An optical coherence tomography angiography study

Author: Federica Fossataro (Italy)

Co-authors: Mariano Cozzi, Giulio Maione, Alfredo Pece

Purpose

To evaluate pigment epithelium detachment (PED) variation and vascular morphological changes after Brolucizumab intravitreal injection in non-responder neovascular age-related macular degeneration (nAMD) patients using Optical Coherence Tomography (OCT) and OCT angiography (OCTA).

Setting/Venue

Retina 3000 Eye Clinic, Milan

Methods

This is a prospective observational case series. Patients diagnosed with nAMD with a non-responder PED to previous treatment with anti-VEGF agents and switched to Brolucizumab were enrolled in this study. In order to be classified as non-responders, patients had to have persistent PED associated with intraretinal/subretinal fluid after at least 3 additional consecutive anti-VEGF injections. All patients underwent structural OCT and OCTA at the same retinal location at the time of the first Brolucizumab injection and fifteen, thirty, and sixty days after treatment. Greatest PED height was measured using the in-built measure distance tool at each visit. Moreover, a qualitative assessment of the macular neovascularization (MNV) was performed during the study period. A paired t-test was used to calculate the variation of the greatest PED height.

Results

Ten eyes of ten patients (mean age 73 SD± 8 years) were enrolled in this study. The mean number of anti-VEGF treatments was 12.6 (SD± 3) during a mean follow-up period of 3 years from the first diagnosis to the last injection before switching. One month after Brolucizumab administration, no activity signs were detected by SD-OCT in all patients. We also found a statistically significant reduction of the greatest PED height after 15 days from the Brolucizumab injection (P<0.05) and a subsequent further decrease after a 1-month follow-up. Greatest PED height was then preserved up to month two (P>0.05). OCTA showed a shrinking of the neovascular network with reduction of peripheral branching vessels and anastomotic arches and appearance of a pruned tree appearance of the vascular loops in 70% of the patients. In 20% no evident morphological changes of the neovascular network were present despite the improvement appreciated from the structural scans while in the last 10% there were an initial decrease of intraretinal fluid, but it was subsequently followed by a structural worsening with persistence of activity signs one month after the injection.

Conlusions

In non-responder patients, Brolucizumab could represent a valid treatment option promoting a reduction of the neovascular exudation. Moreover, we found a significant reduction of chronic PED. Further randomized control studies are necessary to confirm our findings.

Financial Disclosure

The authors do not have any financial relations.