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

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.

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.

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).

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.