The effect of brolucizumab on diabetic macular edema and ischemia; a real-world analysis.

ObjectiveThe response to intravitreal brolucizumab on diabetic macular edema (DME) and macular ischemia was studied in treatment-refractory and treatment-naïve patients.MethodsPatients with either recalcitrant (group 1) or treatment-naïve (group 2) DME were studied before and after intravitreal brolucizumab. All patients underwent a comprehensive ophthalmological examination including optical coherence tomography (OCT) and OCT-angiography (OCT-A). We compared the DME and macular/choriocapillaris ischemia before and after the loading dose.ResultsA total of 33 eyes of 26 patients were examined. 18 eyes were switched to brolucizumab, 15 eyes were treatment naive. All eyes responded with anatomical and functional improvement: group 1: 391 vs 298 μm (p = 0.005), 0.6 ± 0.4 logMAR vs. 0.4 ± 0.4 logMAR) (p = 0.01), group 2: 430 vs 281 μm (p = 0.0007), 0.5 ± 0.2 logMAR vs. 0.2 ± 0.2 logMAR (p = 0.004). In group 2 there was also significant improvement in retinal vascular parameters, especially in the central and inner circles of the ETDRS grid: central capillary density 6.55 vs 9.03 mm/mm2 (p = 0.008), inner 11.2 vs 13, 9 mm/mm2 (p = 0.02), central perfusion density 15.5% vs 20.7% (p = 0.02). Choriocapillaris flow deficit (CCFD%) also improved after the loading dose (40.3 vs. 35.3, p = 0.03). Although not statistically significant, there was also an improved foveal circularity.ConclusionIntravitreal brolucizumab leads to significant functional and anatomical improvement in diabetic macular edema and has also a beneficial effect on macular ischemia as shown by improvement in both retinal and choroidal perfusion.