Comparison of the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment

(2022) 22:387 Mukai et al. BMC Ophthalmology https://doi.org/10.1186/s12886-022-02617-2 Open Access RESEARCH Comparison of the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment Ryo Mukai* , Hidetaka Matsumoto, Kazuki Nagai and Hideo Akiyama Abstract Background: To compare the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment (PED) in age-related macular degeneration. Methods: Eighty-three eyes of 83 patients diagnosed with type 1 macular neovascularization were included and retrospectively analysed using multimodal imaging. Forty-nine eyes were treated with intravitreal aflibercept injections (IVA group), and 34 eyes were treated with brolucizumab (IVBr group), with three consecutive injections administered as induction therapy. Before treatment and 1, 2, and 3 months after the first treatment, the maximum height (MH) and maximum diameter (MD) of the PED were measured using optical coherence tomography in each treatment group. Results: In the IVA group, MH at baseline (228 ± 169 μm) diminished to 180 ± 150 (P = 0.2558), 165 ± 140 (P = 0.0962), and 150 ± 129 µm (P = 0.0284) at 1, 2, and 3 months after treatment, respectively; the reduction at 3 months was significant. In contrast, in the IVBr group, the MH was 307 ± 254 µm before treatment, and it decreased to 183 ± 156 µm (P = 0.0113), 139 ± 114 µm (P = 0.0003), and 125 ± 126 µm (P < 0.0001) at 1, 2, and 3 months after treatment, respectively, and the reduction at 1 month was significant. In both groups, the MD did not regress significantly. Conclusions: The results suggested that the MH of PED after IVBr treatment regressed faster than that after IVA treatment. Keywords: Aflibercept, Age-related macular degeneration, Brolucizumab, Pigment epithelial detachment Background Age-related macular degeneration (AMD) is a significant cause of blindness worldwide. Since 2000, anti-vascular endothelial growth factor (VEGF) drugs have been used to treat exudative lesions of AMD. To date, formulations of bevacizumab [1], pegaptanib [2, 3], ranibizumab [4], and aflibercept [5] have been used to stabilize the disease and thus improve vision. Intensive research has also yielded more potent and longer-acting drugs to treat *Correspondence: Department of Ophthalmology, Gunma University Graduate School of Medicine, 3‑35‑15 Showa‑cho, Maebashi, Gunma 371‑8511, Japan this disease. One such drug, brolucizumab [6, 7], was launched in the United States in 2020 and is now available worldwide. Pigment epithelial detachment (PED) is closely associated with neovascular AMD. Exudative change in the retina with shallow PED indicates the presence of macular neovascularization, especially in the elderly [8]. The presence of a PED which develops due to macular neovascularization (MNV) can cause subretinal fluid, intraretinal fluid, subretinal pigmental epithelial fluid and subretinal or subretinal pigment epithelial (sub-RPE) haemorrhage, with loss of visual acuity [9]. In addition, a large PED associated with MNV can lead to the emergence of RPE tear [10]. Brolucizumab has a strong effect on subretinal pigment epithelial choroidal © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mukai et al. BMC Ophthalmology (2022) 22:387 Page 2 of 6 neovascularization or sub-RPE fluid. HAWK and HARRIER studies revealed that the percentage of patients with sub-RPE fluid treated with intravitreal brolucizumab injections (IVBr) was significantly lower than that of patients treated with intravitreal aflibercept injections (IVA) [11]. Therefore, in this study, we focused on the regressive effect of brolucizumab on PED, and compared the effects of IVA and IVBr in a real-world setting. administered in 2015 and IVBr was administered in 2021. The emergence of idiopathic orbital inflammation (IOI) was monitored monthly. To detect vascular changes in detail, an ultra-wide field scanning laser ophthalmoscope (Optos 200Tx) was used during monitoring. In addition, we assessed retinal haemorrhage and retinal pigment epithelial tears using OCT images, fundus photographs, and autofluorescein images. Methods Institutional review board approval for this retrospective study was obtained from Gunma University Graduate School of Medicine, and the study adhered to the Declaration of Helsinki. All patients with a clinical diagnosis of type 1 MNV and previously untreated neovascular AMD (nAMD) at the Department of Ophthalmology of Gunma University Medical Hospital between June 2015 and January 2021 were included in this study. All participants were examined using fundus ophthalmoscopy, fluorescein angiography (FA), IA (Heidelberg Engineering, Heidelberg, Germany), and swept-source optical coherence tomography (OCT; DRI OCT Triton; Topcon, Tokyo, Japan). The DRI OCT triton incorporated a tuneable laser with a central wavelength of 1050 nm and acquired 100,000 A-scans/s. SS-OCT had an axial resolution of 2.6 μm and a lateral resolution of 20 μm. SS-OCT volume images were obtained using a radial scan protocol, which covered an area of 9 × 9 mm centred on the fovea. In addition, 12-mm horizontal and vertical scans at the fovea that contained 1024 A-scans were obtained and analysed. To evaluate PED regression before and at 1, 2, and 3 months after the first treatment, the maximum height (MH) and maximum diameter (MD) of PED were measured using OCT images in each treatment group. At the initial visit and 3 months after the first treatment, best-corrected visual acuity (BCVA), central macular thickness (CMT), and central choroidal thickness (CCT) were examined. MH was defined as the distance between the RPE and Bruch’s membrane. MD was assessed by measuring the maximum expansion of the PED using radial OCT or crossed-line images. CMT was defined as the distance between the internal limiting membrane and the RPE at the fovea, and CCT was defined as the distance between Bruch’s membrane and the marg (...truncated)