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

Abstract Objective The response to intravitreal brolucizumab on diabetic macular edema and macular ischemia was studied in treatment-refractory and treatment-naïve patients.Methods Patients with either treatment resistant or treatment naive diabetic macular edema were studied retrospectively before and after intravitreal brolucizumab. All patients underwent a comprehensive ophthalmological examination including optical coherence tomography (OCT) and OCT-angiography (OCT-A) to compare their macular edema and macular ischemia before initiation of intravitreal brolucizumab treatment and at the end of the upload phase.Results A total of 31 eyes of 27 diabetic patients were examined. 19 eyes were switched to brolucizumab after long prior anti-VEGF treatment history; 12 eyes were treatment naive with respect to macular edema. All eyes responded positively to brolucizumab with complete resolution of diabetic macular edema: group 1: 369 vs 302 µm (p = 0.007), group 2: 415 vs 259 µm (p = 0.01). All eyes also manifested improvement in vision: group 1: 0.3 vs 0 .6 (0.5 ± 0.5 logMAR vs. 0.22 ± 0.5 logMAR) (p = 0.01), group 2: 0.3 vs 0.5 (0.5 ± 0.7 logMAR vs. 0.2 ± 0.7 logMAR) (p = 0.00002). Interestingly, in group 2 there was also significant improvement in vessel and perfusion density, especially in the central and inner diameter: central vessel density of 6.55 vs 9.03 mm/mm² (p = 0.008), inner of 11.2 vs 13, 9 mm/mm² (p = 0.02), and central perfusion density of 15.5% vs 20.7% (p = 0.02). Although not statistically significant, there was also a tendency to improved foveal circularity.Conclusion Intravitreal brolucizumab leads to significant functional and anatomical improvement in diabetic macular edema and has also a beneficial effect on macular ischemia reflected by foveal capillary anatomy and perfusion density.