Novel Resolution of Multilayered Pigment Epithelial Detachment Lamellae Following Brolucizumab Treatment-A Case Report.

Purpose: The aim of this study is to report a unique case where brolucizumab administration resolved multilayered pigment epithelial detachment (MLPED) lamellae. Observations: An 80-year-old gentleman with polypoidal choroidal vasculopathy developed MLPED from long-term ranibizumab treatment. Switching to brolucizumab led to visual acuity improvement after three doses and complete resolution of fluid, reduced choroidal thickness, and MLPED collapse. Notably, the patient experienced a recurrence of MLPED, which again resolved after the fourth dose of brolucizumab. Conclusions and Importance: This case underscores the effectiveness of brolucizumab in resolving MLPED lamellae, a previously unreported phenomenon. Furthermore, it highlights the potential for visual acuity improvement despite MLPED resolution. Brolucizumab's mechanism of action, including its potent antivascular endothelial growth factor properties and enhanced tissue penetration, may contribute to the collapse of MLPED by modulating subretinal pigment epithelial fluid dynamics. Further research into molecular pathways, cellular interactions, and safety profiles is warranted to optimize the therapeutic role of brolucizumab.