Long-term analysis of intravitreal brolucizumab in recalcitrant cases of chronic central serous retinopathy complicated by neovascularization (pachychoroid neovasculopathy).

PURPOSE: To assess the long-term safety and efficacy of intravitreal brolucizumab (Pagenax®) in eyes with chronic central serous chorioretinopathy (CSC) complicated by neovascularization (pachychoroid neovasculopathy) refractory to prior therapies.

METHODS

In this single-center retrospective case series (January 2021-July 2025), 30 eyes of 25 patients with recalcitrant and refractory cases of chronic CSC with secondary neovascularization were treated off-label with pro-re-nata intravitreal brolucizumab. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and pigment epithelial detachment (PED) height were measured at baseline and 6 months, with extended outcomes in nine eyes assessed at 1 and 2 years. Adverse events were recorded at each visit.

RESULTS

At 6 months, the mean CST decreased significantly from 328 ± 222 µm to 172 ± 79 µm ( P < 0.001), and the PED height declined from 262 ± 192 µm to 155 ± 123 µm ( P = 0.027). BCVA improved or remained stable in 90% of eyes, with no significant change in mean logMAR (0.38 to 0.33, P = 0.314). In the extended cohort, CST reductions persisted at 1 year (412 ± 241 µm to 271 ± 239 µm, P = 0.009) and 2 years (412 ± 241 µm to 164 ± 42 µm, P = 0.004), while BCVA stayed stable. A weak correlation suggested more injections might be linked to slightly poorer BCVA, possibly due to resistant cases requiring more treatment. No adverse events were noted.

CONCLUSION

Intravitreal brolucizumab administered PRN effectively resolves persistent fluid and reduces PED in chronic CSC with PNV refractory to prior treatments, while maintaining stable visual acuity and demonstrating a favorable safety profile through 2 years of follow-up.