Three-Year Real-World Outcomes of Switching to Brolucizumab for Refractory Neovascular Age-Related Macular Degeneration

Objectives: To evaluate the three-year long-term efficacy, treatment durability, and safety of switching to brolucizumab in patients with neovascular age-related macular degeneration (nAMD) who were refractory to previous anti-vascular endothelial growth factor (anti-VEGF) agents in a real-world setting. Methods: This retrospective study included nAMD patients who switched to brolucizumab between July 2021 and November 2022. Clinical outcomes were evaluated based on changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and the presence of retinal fluid, as well as changes in annual injection frequency and treatment intervals. Safety outcomes, including intraocular inflammation (IOI), were also assessed. Results: A total of 123 patients were initially reviewed. After excluding patients who did not complete the 3-year follow-up or met exclusion criteria, 47 eyes of 47 patients were included in the final efficacy analysis. Mean BCVA significantly improved from 0.33 ± 0.24 logMAR at baseline to 0.27 ± 0.20 logMAR at 3 years (p < 0.05). Mean CMT demonstrated a significant and sustained reduction from 333.36 ± 136.05 µm at baseline to 232.06 ± 68.90 µm at 3 years (p < 0.001). By the end of the 3-year period, 70.2% of patients successfully achieved an extended treatment interval of ≥16 weeks. IOI was observed in 3.3% of patients but was manageable, with no cases of retinal vasculitis or retinal vascular occlusion observed. Conclusions: Switching to brolucizumab provided maintained visual and anatomical improvements with extended treatment intervals over 3 years. The safety profile was consistent with previous reports, and IOI events were manageable in a real-world setting.