Short-term safety and efficacy of intravitreal brolucizumab injections for neovascular age-related macular degeneration: a multicenter retrospective real-world study

Introduction: To determine the short-term real-world safety and efficacy of intravitreal brolucizumab injections in Korean patients with neovascular age-related macular degeneration (nAMD).Methods: This multicenter retrospective study involved 294 eyes (treatment naive 20 eye (6.8%) and non-treatment naive 274 eyes (93.2%)) of 290 patients from 13 hospitals or retinal centers in South Korea. Patients with nAMD who received brolucizumab injection(s) between April 1 and November 30, 2021, with a follow-up >= 1 month, were included. Primary outcomes were safety, incidence of intraocular inflammation (IOI), and potential risk factors. The secondary outcome was efficacy, i.e., change in best-corrected visual acuity (BCVA) and optical coherence tomography-measured macular thickness and retinal fluid. Results: The mean age was 71.63 +/- 8.66. The follow-up period was 2.38 +/- 0.79 months. The mean number of brolucizumab injections during the follow-up was 1.52 +/- 0.58. The overall incidence of IOI was 13.9% (n=41 eyes). Most IOI cases were of anterior uveitis (8.8%, 26 eyes), followed by retinal vasculitis (2.4%, seven eyes) and occlusive retinal vasculitis (0.3%, one eye). Most eyes showed IOI resolution (n=40, 97.5%) and BCVA restoration (n=39, 95.1%) with or without corticosteroid treatment during the follow-up. Age, sex, IOI history, or other anti-vascular endothelial growth factor injection histories were not associated with the occurrence of IOI. However, only thin subfoveal choroidal thickness (SFCT) was associated with the occurrence of IOI (odds ratio=0.995, p=0.020). BCVA at 1 month improved from baseline (Baseline 0.518 +/- 0.356 vs. 1 month 0.503 +/- 0.383, p=0.023), but the improvement was not maintained. Anatomical improvement was significant after 3 months.Conclusion: IOI was well-controlled with or without steroid treatment. Most IOI eyes (95.1%) were restored to the level of vision before IOI occurrence and occlusive vasculitis was rare. In the short term, brolucizumab injection effectively improved vision at 1 month and dried retinal fluid for 3 months.