Efficacy of Intravitreal Brolucizumab Switch in Pachychoroid Neovasculopathy

Introduction: This study aimed to evaluate the anatomical and functional outcomes of switching to intravitreally administered brolucizumab (Beovu®, Novartis) in patients affected by pachychoroid neovasculopathy (PNV) who were considered as non-responders to previous anti-vascular endothelial growth factor (anti-VEGF) therapies, defined as the persistence of intraretinal fluid (IRF), subretinal fluid (SRF), or subretinal hyper-reflective material (SHRM). Methods: Twenty-three eyes of 21 patients with exudative PNV, who were switched to brolucizumab between April 2021 and December 2023, were retrospectively enrolled. All patients had previously received at least one injection of another anti-VEGF agent. Following the switch (baseline), patients received brolucizumab under a pro re nata regimen and were followed for 12 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CT), and height of IRF, SRF, SHRM, and pigment epithelial detachment (PED) were assessed at baseline and at the 12-month follow-up. Results: At 12 months after the switch to brolucizumab (mean 5.26 injections), BCVA remained stable (20/50, 0.4 logMAR). However, significant anatomical improvements were observed, including a reduction in SRF (97–18 µm, p = 0.002), SHRM (75–0 µm, p = 0.008), and CT (379–337 µm, p < 0.001). Resolution of IRF was achieved in 70% of eyes and SHRM in 87%. A median of 2 brolucizumab injections were required to achieve fluid control (absence of both IRF and SRF). Notably, the number of injections needed for complete SRF resolution predicted final BCVA. Conclusion: In our cohort of patients with PNV, switching to brolucizumab demonstrated a significant anatomical response, leading to a reduction in exudative features. While BCVA remained stable, the number of brolucizumab injections required to resolve SRF emerged as a predictor of final visual outcome, suggesting that an earlier switch in non-responders might optimize anatomical results. The safety profile of brolucizumab in this study was favourable, with no severe inflammatory adverse events reported.