Decrease in Ocular Blood Flow Thirty Minutes After Intravitreal Injections of Brolucizumab and Aflibercept for Neovascular Age-Related Macular Degeneration

Abstract

Purpose Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents such as brolucizumab and aflibercept are used widely to treat neovascular age-related macular degeneration (nAMD); however; they may theoretically affect the ocular blood flow. We investigated the short-term changes in the ocular blood flow between eyes with nAMD treated with intravitreal brolucizumab injections (IVBr) and intravitreal aflibercept injections (IVA). Methods This study included 21 eyes of 21 Japanese patients with nAMD treated with either IVBr or IVA at Kurume University Hospital from April 2021 through June 2022. The rates of ocular blood flow at the optic nerve head (ONH mean blur rate [MBR]-vessel) and at the choroid (CHOR MBR) were analyzed before and 30 minutes after injections using laser speckle flowgraphy. Results In the IVBr-treated group, the ONH MBR-vessel and CHOR MBR rates decreased significantly by 10.6% and 16.9% from baseline to 30 minutes after IVBr, respectively. In the IVA-treated group, ONH MBR-vessel and CHOR MBR rates decreased significantly by 9.4% and 6.1% from baseline to 30 minutes after IVA, respectively. There was no significant difference in the rates of decrease in the ONH MBR-vessel or CHOR MBR between the IVBr-treated and IVA-treated groups. Conclusion Intravitreal injections of brolucizumab and aflibercept in eyes with nAMD cause significant decreases in ocular blood flow at the ONH and the choroid 30 minutes after injection. The rate of decrease in ocular blood flow was not significant between the eyes treated with brolucizumab and aflibercept. However, 3 of 10 eyes treated with brolucizumab but none of 11 eyes treated with aflibercept had more than a 30% decrease in the ocular blood flow at the choroid 30 minutes after injection.

Subclinical Ocular Changes after Intravitreal Injections of Different Anti-VEGF Agents for Neovascular Age-Related Macular Degeneration

“…This property could have prolonged the inhibition of VEGF activity and may have affected the retinal circulation after the intravitreal injection. In fact, in a report evaluating the ocular perfusion at 30 min after IVA or IVBr injections in nAMD eyes, there were 3 of 10 patients in the IVBr group with perfusion reductions of 30% or greater, compared to 0 patients in the IVA group [33]. Together with the high complication rates of RO after IVBr, these results indicate that the reduction in ocular perfusion with brolucizumab may be different from that caused by other anti-VEGF drugs.…”

“…It is also known that anti-VEGF drugs affect the ocular circulation. It has been reported that the ocular perfusion [31][32][33] and the choroidal thickness decreased after IVA or IVBr injections [34,35]. A laser blood flowmeter was used to show that ranibizumab decreased the retinal arterial vessel diameter, velocity, and blood flow in patients with nAMD who had received fewer ranibizumab treatments [36].…”