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Background:   Some patients with neovascular age-related macular degeneration (nAMD) have persistent intraretinal/subretinal fluid (IRF/SRF) despite being treated with anti-VEGF agents. There is limited data on efficacy of switching to intravitreal brolucizumab (IVBr) in these patients.Purpose:   To determine anatomic and visual outcomes of eyes with nAMD treated with for persistent IRF/SRF.Methods:   Retrospective series of eyes with nAMD treated initially with aflibercept (IVA, n = 48) and bevacizumab (IVBe, n = 10), then switched to IVBr for persistent IRF/SRF.Results:   In the IVA-IVBr group, a mean of 42 days after one IVBr, mean logMAR changed from 0.50 to 0.49 ( p = 0.73) and mean CSFT changed from 340 to 305 µm ( p &lt; 0.001); 31% of eyes had no fluid, 42% had persistent but reduced fluid, 25% had stable fluid, and 2% had increased fluid. For a subgroup of 25 eyes that completed a series of 3 IVBr, mean logMAR changed from 0.44 to 0.40 ( p = 0.35) and mean CSFT changed from 325 to 277 µm ( p = 0.001); 24% of eyes had no fluid at last follow-up, a mean of 54 days after last IVBr. In the IVBe-IVBr group, a mean of 44 days after one IVBr, mean logMAR changed from 0.46 to 0.40 ( p = 0.114) and mean CSFT from 401 to 325 µm ( p = 0.009); 30% of eyes had no fluid and 70% had persistent but reduced fluid. For a subgroup of four eyes that completed a series of three IVBr, mean logMAR changed from 0.33 to 0.35 ( p = 0.391) and mean CSFT improved from 375 to 275 µm ( p = 0.001); 50% of eyes had no fluid at last follow-up, a mean of 65 days after last IVBr.Conclusion:   In nAMD eyes previously treated with IVA and IVBe, switching to IVBr significantly reduced persistent IRF/SRF but did not significantly affect visual outcomes.

Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments