Experience with Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration

Abstract

Purpose: To assess efficacy and safety profile of intravitreal brolucizumab in patients with neovascular age-related macular degeneration (nAMD) in real clinical practice.Patients and Methods. This study enrolled 21 patients with nAMD (treatment-naïve), including 12 women, 9 men, mean age was 73.5 ± 9.8 years. One patient was excluded from the study after 3 intravitreal injection (IVI) due to the development of the intraocular inflammation (IOI). All patients received 5 IVI of brolucizumab (in total, 100 injections). All patients were determined best-corrected visual acuity (BCVA). Intraretinal fluid (IRF), subretinal fluid (SRF), central macular thickness (CMT), and pigment epithelial detachment (PED) were evaluated by optical coherence tomography. Intraocular pressure (IOP) was measured before IVI, after 1 minute, 30 minutes. Patients were examined before treatment, after 3 and 5 IVI.Results. The average follow-up period for patients was 31 ± 2.5 weeks, the average interval after 3 loading doses was 8.4 ± 1.2 weeks, the average interval between 4 IVI and 5 IVI was 10.7 ± 1.9 weeks. The BCVA improved significantly after 3 IVI and after 5 IVI of brolucizumab (p < 0.001). There was a statistically significant decrease in CMT and PED height (p < 0.001), as well as a resolution of all types of fluid (p < 0.001). All patients showed a significant increase in IOP immediately after injection (1 min) with normalization of IOP after 30 min. One case of IOI was registered 16 weeks after the start of treatment, cured by IVI of dexamethasone implant Ozurdex.Conclusion. Patients with nAMD (treatment-naïve) who received 5 IVI of brolucizumab demonstrated a significant improvement of morphological and functional parameters. Brolucizumab has shown efficacy in the treatment of nAMD despite a small risk of IOI.

Intraocular Inflammation Associated with Intravitreal Drug Injections: Current State of the Problem

“…Разработанные схемы лечения БАРВ, включающие периокулярное, интравитреальное и системное применение кортикостероидов, которое при необходимости дополняется витрэктомией [28,36], позволили существенно улучшить функциональные исходы этого грозного НЯ [51,56]. При этом, по мнению ряда экспертов, применение бролуцизумаба требует дополнительных возможностей лечебного учреждения (включая диагностическое оборудование, наличие круглосуточного стационара, условия для проведения витреоретинальной хирургии), а также связано с необходимостью более строгого наблюдения за пациентами по сравнению с тем, которое проводится обычно при анти-VEGF-терапии другими препаратами [43,46].…”