Brolucizumab Intravitreal Injection in Macular Neovascularization Type 1: VA, SD-OCT, and OCTA Parameter Changes during a 16-Week Follow-Up

Abstract

Purpose: to assess the anatomical and functional changes after brolucizumab intravitreal injection (BIVI) in macular neovascularization type 1 (MNV1). Setting/Venue: Ophthalmology Clinic, University "G. d'Annunzio" of Chieti-Pescara. Methods: A total of 24 eyes of 24 patients suffering from naïve MNV1 candidates to BIVI as per label with q12/q8 dosing regimen after the loading dose were enrolled in this prospective study. Main outcome measures during a 16-weeks follow up period included changes of best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal subretinal fluid thickness (SSRFT), subfoveal sub-RPE fluid thickness (SSRPEFT), subfoveal choroidal thickness (SFCT) and pigment epithelial detachment (PED) maximum height (PED-MH). In addition, percentages of eyes with intraretinal fluid, subretinal fluid and sub-RPE fluid at different time points and percentages of eyes candidates to a q8 or q 12 injection interval after disease activity assessment at week 16 were evaluated. Results: BCVA improved significantly from baseline (T0) to week 12 (T3) (p=0.028). CMT showed a significant reduction from 456.0±123.0 µm at T0 to 265.0±85.0 µm at T3 (p<0.001). SSRFT and SSRPEFT reduced significantly as well (p<0.001 and p=0.049 respectively). PED-MH reduced significantly from 162.0±110.0 µm at T0 to 94.1±38.9 µm at T3 (p=0.020) and SFCT from 203.0±56.9 µm at T0 to 146.0±64.2 µm at T3 (p=0.006). IRF presence changed significantly from 41.7% of eyes at T0 to 20.8% at T3 (p=0.045). SSRF reduced significantly during follow up, being present in 62.5% of eyes at T0 and 4.2% of eyes at T3 (p<0.001). Subfoveal sub-RPE fluid decreased significantly during time being present in 20.8% of eyes at T0 and 0% at T3 (p=0.013). Most of the eyes (18 eyes, 75%) at week 16 after disease activity assessment were shifted in the q12 interval and only a minority of eyes shifted in a q8 interval (6 eyes, 25%). CC Flow and ORCC flow did not show significant differences during follow up. Conclusions: Brolucizumab is efficient in reducing all retinal fluids during the loading phase and shows reduction of macular thickness, choroidal thickness, and PED height. Most eyes at disease activity assessment (75%) fall into 12 week-interval and the minority (25%) into the 8 week-interval.

Functional and anatomical outcomes of brolucizumab for nAMD in a real-life setting

“…As regards naïve patients, we showed a statistical reduction of PED-MH after the loading phase. This is in accordance with Toto et al 18 , who demonstrated a significant reduction between baseline and week 16 in naïve type 1 MNV. Thanks to our longer follow-up, the maintenance of the statistical result at week 24 and the last follow-up could also be demonstrated.…”

“…Mishra et al demonstrated that both IRF and SRF were detected in 82.1% of patients at baseline; after the loading phase, they reduced respectively to 41.1% and 16.1% 22 . Toto et al 18 showed a reduction in IRF and subfoveal-SRF rates in type 1 MNV between baseline and week 12, respectively changing from 41.7 to 20.8% and from 62.5 to 4.2%. The greater amount of unresponsive fluid in the intraretinal compartment may represent a biomarker of degenerative cystoid processes 23 .…”

Long-Term Follow-Up of Brolucizumab in Macular Neovascularization

“…Consistent with our previous results, the 1-year followup confirmed the efficacy of brolucizumab in patients with G1 by observing improved BCVA and reduction of CMT and SCT [13]. CMT has been considered a validated biomarker of activity and final endpoint for different studies [16,17].…”

“…In our previous work, brolucizumab demonstrated to be efficient in a 16-week interval in patients with naïve G1 in reducing OCT and OCT-A biomarkers mirror of the disease activity and improving visual acuity with overall patient satisfaction [13]. The aim of our new study was to analyze structural and morphofunctional changes occurring in naïve eyes with G1 and G2 treated with brolucizumab in a 1-year interval.…”

“…In our previous study, we assessed the functional and anatomical changes in MNV type 1 naïve patients in the loading phase up to week 16 after IVBr treatment administered as per label finding improved the anatomical and functional parameters [13]. The aim of the present study was to evaluate functional and anatomical changes occurring in patients with type 1 and type 2 naïve MNV treated with IVBr injections up to week 48.…”