Outcomes of Re-Switching Anti-vascular Endothelial Growth Factor After Brolucizumab-Associated Inflammation in Age-related macular degeneration

To investigate the anatomical and functional outcomes in cases of re-switching to previous anti-vascular endothelial growth factor (VEGF) agents due to intraocular inflammation (IOI) following a switch to brolucizumab in neovascular age-related macular degeneration (nAMD). This study included patients with nAMD who switched to brolucizumab and discontinued brolucizumab treatment due to IOI, with a follow-up duration of at least 6 months before and after brolucizumab treatment period. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and retinal fluid on optical coherence tomography were evaluated. A total of 16 eyes from 16 patients were reviewed. 12.5% of patients achieved complete fluid resolution before brolucizumab treatment, which increased to 93.8% during brolucizumab therapy. However, after switching back to other anti-VEGF agents, the proportion of patients with dry macula decreased to 37.5%. There were no statistically significant changes in BCVA, CMT, or CCT throughout the study period. In cases where brolucizumab treatment was discontinued due to IOI and switched back to other anti-VEGF agents, the anatomical response was insufficient, indicating the need for alternative treatment options.