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.