Three-year visual outcomes after brolucizumab in patients with neovascular age-related macular degeneration.

BACKGROUND

The purpose of this study is to investigate the 3-year outcomes of intravitreal brolucizumab and determine the factors that affect the visual acuity (VA) in patients with neovascular age-related macular degeneration.

METHODS

All received three consecutive, monthly, induction brolucizumab injections (6.0 mg/0.05 ml) and fixed-dose every 2-or-3-month treatment for 12 months, after which a pro re nata (PRN) or treat-and-extend (TAE) regimen began. Best-corrected VAs (BCVAs) on a Landolt C eye chart were compared before and 4, 12, and 36 months after initial treatment. Factors affecting VA improvements and morphologic characteristics associated with VA at 36 months were determined.

RESULTS

Fifty-nine eyes were assessed at 36 months. The mean logMAR BCVAs at baseline and 4, 12, and 36 months after the initial injection were 0.37 ± 0.39, 0.34 ± 0.48, 0.30 ± 0.47, and 0.36 ± 0.51 in the PRN group and 0.31 ± 0.28, 0.22 ± 0.27, 0.18 ± 0.28, and 0.20 ± 0.31 in the TAE group, respectively. In the PRN group, post-injection BCVA did not improve significantly compared with baseline throughout 36 months (p = 0.999, p = 0.814, and p = 0.999 at 4, 12, and 36 months, respectively). In the TAE group, the post-injection BCVA at 12 and 36 months improved significantly compared with baseline (p = 0.006 and p = 0.032, respectively). The baseline BCVA, central foveal thickness (CFT) and TAE regimen were associated with improved VA (p < 0.05 for all). Eyes with subretinal fluid (SRF) at 36 months had significantly better VA (p = 0.019).

CONCLUSION

The TAE regimen achieved better visual outcomes at 3 years. Residual SRF should be tolerated during the maintenance phase if the change of CFT was little compared to the previous image.