The impact of ocular hypertension on retinal nerve fiber layer and optic disc perfusion during treatment with brolucizumab in patients with neovascular form of age-related macular degeneration

PURPOSE. To evaluate the effect of elevated intraocular pressure (IOP) after multiple intravitreal injections (IVI) of brolucizumab on changes in the retinal nerve fiber layer (RNFL) and perfusion of the optic nerve head.

METHODS. The study included 20 patients with newly diagnosed exudative form of age-related macular degeneration (AMD). All patients underwent IVI of brolucizumab. IOP measurements were taken with an ICare Pro tonometer before IVI, one minute after IVI, then after 30 minutes and 180 minutes. Thickness of the peripapillary RNFL was measured using Spectralis OCT (Heidelberg Engineering, Germany). The optic disc was examined using OCT angiography on Revo NX (Optopol Technology SA, Poland). All studies were carried out before the start of treatment, after one month, after the third injection, and one year after the start of treatment.

RESULTS. Analysis of peripapillary scans in a patient with a history of multiple IVI a year after the start of treatment with brolucizumab showed a statistically significant decrease in perfusion density and fractal dimensions (skeleton) in the entire optic nerve head (ONH) (p<0.001), in the inner ONH area (p<0.001, p=0.01, respectively), in the nasal sector (p=0.03, p=0.04, respectively), temporal sector (p<0.001) and inferotemporal sector (p=0.03) according to OCT angiography. It was determined that a greater increase of IOP one min after IVI was associated with a greater decrease in the density and fractal dimensions of the radial peripapillary capillaries of the inner ONH (p=0.005, rs=0.5; p=0.004, rs=0.6, respectively). A decrease in RNFL thickness was found one year after the start of IVI treatment with brolucizumab (p<0.001).

CONCLUSION. According to OCT angiography, vascular perfusion density of the ONH was decreased during IVI of brolucizumab, and RNFL thickness was also decreased one year after the start of treatment.

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