Punctate Hyperfluorescence as a Favorable Predictive Factor for Treatment Response Following a Switch to Brolucizumab for Patients with Aflibercept-Refractory Neovascular Age-Related Macular Degeneration

<b>Background/Objectives:</b> To identify the predictive biomarkers of treatment response following a switch to brolucizumab in patients with aflibercept-refractory neovascular age-related macular degeneration (nAMD). <b>Methods</b>: This retrospective study included 47 eyes of 44 patients with nAMD who were switched to brolucizumab; a two-year follow-up was completed for 37 eyes of 34 patients after the switch. The patients were classified into two groups based on the presence (fluid group) or absence (dry group) of retinal fluid at one and two years after switching, and their visual acuity, central retinal thickness, subfoveal choroidal thickness, injection interval, and dry macular rate were evaluated. <b>Results</b>: A dry macula was achieved for approximately 80% of patients at two years after the switch (<i>p</i> < 0.001), and the mean injection interval was significantly extended from 6.4 ± 1.8 weeks to 10.5 ± 2.6 weeks during the same period (<i>p</i> < 0.001). Both the mean central retinal thickness and subfoveal choroidal thickness showed a significant decrease at two years after the switch (<i>p</i> < 0.001 for both). A significantly higher proportion of patients in the Dry group exhibited punctate hyperfluorescence in the fellow eye (<i>p</i> < 0.001), and all patients in the dry group achieved a dry macula at two years. <b>Conclusions</b>: Switching to brolucizumab may be an effective treatment option for patients with aflibercept-refractory nAMD. Punctate hyperfluorescence may serve as a favorable prognostic factor following a switch to brolucizumab.