J Retin.  2024 Nov;9(2):169-176. 10.21561/jor.2024.9.2.169.

Long-Term Effect of Intravitreal Brolucizumab Injections on Peripapillary Retinal Nerve Fiber Layer Thickness in Patients with Refractory Polypoidal Choroidal Vasculopathy

• Hwang G
• Hwang DDJ

• KMID: 2561880
• DOI: http://doi.org/10.21561/jor.2024.9.2.169

Abstract

Purpose
This study aimed to evaluate the long-term effects of intravitreal brolucizumab (IVB) injections on peripapillary retinal nerve fiber layer (RNFL) thickness in patients with polypoidal choroidal vasculopathy (PCV).
Methods
This retrospective case series included 11 eyes from 11 patients with PCV who were switched to IVB treatment due to persistent fluid accumulation despite prior anti-vascular endothelial growth factor (VEGF) therapy. RNFL thickness was measured using spectral-domain optical coherence tomography at baseline and 1, 3, 6, 9, and 12 months post-IVB injection. The data were compared to baseline data of treated eyes and untreated fellow eyes.
Results
A significant decrease in RNFL thickness was observed in the inferior temporal sector of the treated eyes at 1 month post-IVB injection compared to baseline (p = 0.029). However, this difference was not significant at subsequent follow-up points. No significant long-term changes were noted in global RNFL thickness or other RNFL sectors compared to baseline. Additionally, there were no significant differences in RNFL thickness between IVB-treated and -untreated fellow eyes at any follow-up visit. Central macular thickness decreased significantly from baseline over the 12-month study period, but BCVA did not significantly differ from baseline at any time point.
Conclusions
Long-term use of IVB in PCV patients does not lead to significant changes in RNFL thickness in treated eyes relative to untreated fellow eyes. The initial decrease in RNFL thickness in the inferior temporal sector may be due to a reduction in macular edema rather than neurotoxicity caused by anti-VEGF treatment. These findings suggest that IVB treatment for PCV does not have a detrimental impact on RNFL thickness over 12 months.

Keyword

Brolucizumab; Polypoidal choroidal vasculopathy; Retinal nerve fiber layer; Vascular endothelial growth factor