Response of extra-large pigment epithelial detachment to intravitreal brolucizumab injection

PURPOSE: To determine the role of intravitreal injection (IVI) of brolucizumab for extra-large pigment epithelial detachment (PED) secondary to macular neovascularization (MNV). OBSERVATIONS: A prospective, non-randomized, uncontrolled case series of three eyes of three patients with extra-large PED (maximum height >350 μm) due to untreated MNV was undertaken at a single center. All three eyes showed significant improvement in the PED height by week 4, with complete resolution by week 8 in two of the three. The third patient who received the second dose is scheduled for a follow-up. Simultaneous notable visual improvement was also observed in all of the eyes. Furthermore, there were no ocular or systemic safety concerns in any of the cases. CONCLUSIONS AND IMPORTANCE: Our real-world case series indicates that intravitreal brolucizumab is efficacious and safe for the management of extra-large PEDs in treatment-naïve MNV eyes. To better understand brolucizumab's mechanism of action, particularly at the sub-RPE and choroidal levels, and the underlying functional principle for the PED response, more study of the drug's pharmacotherapeutics is warranted.