Comparison of ocular blood flow changes at 30 minutes after intravitreal injection of faricimab, brolucizumab, and aflibercept 2 mg for neovascular age-related macular degeneration.

PURPOSE

To investigate ocular blood flow before and 30 minutes post-injection of anti-vascular endothelial growth factor (anti-VEGF) agents in eyes with neovascular age-related macular degeneration (nAMD) and to compare the reduction rates of ocular blood flow among three groups: intravitreal faricimab injections (faricimab-treated), intravitreal brolucizumab injections (brolucizumab-treated), and intravitreal aflibercept 2 mg injections (aflibercept-treated).

METHODS

This retrospective observational case series included 45 eyes of 45 Japanese patients with nAMD treated with faricimab, brolucizumab, or aflibercept 2 mg. Ocular blood flow at the optic nerve head (ONH MV) and the choroid (choroid MBR) was analyzed before and 30 minutes after injections using laser speckle flowgraphy.

RESULTS

The mean ONH MV and choroid MBR decreased significantly 30 minutes post-injection by 12.0% ± 15.3% and 9.7% ± 8.8% in the faricimab-treated group, 9.5% ± 7.9% and 18.2% ± 12.9% in the brolucizumab-treated group, and 10.4% ± 11.9% and 6.0% ± 7.7% in the aflibercept-treated group. There were no significant differences in the reduction rates of ONH MV among the three groups. However, the brolucizumab-treated group showed a greater reduction in choroid MBR than the aflibercept-treated group (faricimab vs. brolucizumab: p = 0.161; faricimab vs. aflibercept: p = 0.631; brolucizumab vs. aflibercept: p = 0.027).

CONCLUSION

Ocular blood flow significantly decreased 30 minutes post-injection in faricimab-, brolucizumab-, or aflibercept-treated eyes with nAMD. Brolucizumab-treated eyes showed a significantly greater reduction in choroidal blood flow than aflibercept-treated eyes.