Rev Bras Oftalmol.2026;85:e0086
Intravitreal injection switch to brolucizumab in refractory and chronic neovascular age-related macular degeneration: a real-world study in Brazil
DOI: 10.37039/1982.8551.20260086
ABSTRACT
Objective:
To evaluate the therapeutic response to brolucizumab in eyes with chronic neovascular age-related macular degeneration (nAMD) refractory to prior anti-angiogenic treatments.
Methods:
This prospective observational study included patients with chronic nAMD who maintained exudative neovascularization after at least three injections of ranibizumab and/or aflibercept without previous episodes of uveitis or vasculitis. Participants received one to three intravitreal injections of brolucizumab. Best-corrected visual acuity (BCVA) was assessed before and 4 weeks after each injection, along with analysis of fluid distribution and measurement of central subfield thickness (CST) using optical coherence tomography.
Results:
Nine eyes from seven patients were included. CST reduced in 7 eyes after the first injection (mean reduction of 30.9%). There was significant resolution of subretinal fluid (p = 0.025), and complete fluid reabsorption in all five eyes that received three injections. No significant change in BCVA was observed. Out of 21 injections, 5 (23.8%) resulted in mild adverse events, with no severe cases observed.
Conclusion:
Brolucizumab may be an effective therapeutic alternative for refractory nAMD. Although there was no improvement in BCVA, the treatment promoted complete fluid resolution after one to three doses, and no severe adverse effects were observed in this small series.
