Intravitreal Brolucizumab Use for Retinal Vascular Diseases in Resource-Constrained Settings: A Retrospective Study From Bangladesh

Background Anti-Vascular Endothelial Growth Factor (VEGF) therapy has been proven effective and safe for retinal vascular diseases, but the use of this agent is scarce in resource-constrained countries, including Bangladesh. Considering the limited literature, we have described 17 cases and their outcome using an anti-VEGF agent (brolucizumab) for retinal vascular diseases. Methods This retrospective case review described patients undergoing intravitreal brolucizumab at a tertiary eye care center in Bangladesh from January 2022 to December 2023. Eighteen eyes of 17 patients with complete best corrected visual acuity (BCVA) data for four follow-ups were included. Outcomes of the treatment over six months were changes in BCVA and optical coherence tomography (OCT) measurements, including foveal center point thickness, central subfield retinal thickness, and macular volume. Results Ten eyes were refractory cases who switched from other anti-VEGF agents, while eight were treatment naïve. The median age of the patients was 56 years (Interquartile range or IQR: 48-68 years). Out of all, 52.9% were female patients (n=9) and 47.1% were male patients (n=8). Diabetic retinopathy (n=10, 55.6%) was the most common indication, followed by age-related macular degeneration (n=6, 33.3%). Average BCVA improved in both naïve and refractory eyes over the course of treatment. Median OCT measurements showed a decrease in both naïve and refractory cases. No adverse events occurred. Conclusion Brolucizumab demonstrated visual gain in the short term with a favorable safety profile in a series of cases in the real-world settings of Bangladesh. Larger studies with extended follow-up can further elucidate its long-term utility.