Background: To report on the outcome of intravitreal brolucizumab compared to aflibercept in patients with diabetic macular edema (DME). Methods: Prospective, observational, study in 35 eyes of 24 patients with a loading dose of five injections of 6 mg brolucizumab every 6 weeks (q6w, treatment-naïve eyes) or a minimum of two injections of brolucizumab q6w after the switch (recalcitrant DME eyes), followed by a treat and extend (T&E) regimen. The results were compared with 40 eyes of 31 DME patients who were treated with aflibercept. The data were obtained from the Berlin Macula Registry. The primary outcome measure was the change in best-corrected visual acuity (BCVA) at week 36. Secondary outcome measures were the change in central retinal thickness (CRT) and the treatment intervals until week 36. Results: BCVA increased significantly in treatment-naïve DME eyes treated with either brolucizumab (+0.12 logMAR, +6.4 letters, p = 0.03) or aflibercept (+0.19 logMAR, +9.5 letters, p = 0.001). In recalcitrant DME eyes, BCVA also increased significantly after switching to brolucizumab (+0.1 logMAR, +5 letters, p = 0.006) or aflibercept (+0.11 logMAR, +5.5 letters, p = 0.02). All treatment-naïve and recalcitrant DME eyes had a significant decrease in CRT after treatment with brolucizumab (p = 0.001 and p < 0.001) or aflibercept (p = 0.0002 and p = 0.03). At week 36, the mean treatment interval for brolucizumab was 11.3 weeks, while for aflibercept, it was 6.5 weeks for treatment-naïve eyes and 9.3 weeks vs. 5.3 weeks for pretreated eyes. Conclusions: In routine clinical practice, patients with treatment-naïve and recalcitrant DME showed a favorable response to brolucizumab and aflibercept therapy, with a reduced injection frequency after brolucizumab treatment.

Cataract and age-related macular degeneration (AMD) share age as a main risk factor and thus have a high coincidence. Both conditions substantially reduce visual acuity. This study aimed to assess the impact of cataract surgery on visual acuity, retinal morphology, and vascular-endothelial-growth-factor (VEGF) inhibitor therapy in patients with AMD. This study was designed as a retrospective, monocentric, real-world study. Patients diagnosed with either dry AMD or neovascular AMD undergoing cataract surgery at Charité Campus Benjamin Franklin. Treatment data were extracted from the Berlin Macular Registry. Best-corrected visual acuity (BCVA) and macular optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), macular volume (MV), presence of macular edema, intraretinal or subretinal fluid and pigment epithelial detachment were assessed. Primary outcome measure was the postoperative BCVA. Secondary outcomes included postoperative CRT, MV, changes in qualitative OCT parameters, alterations in anti-VEGF-therapy interval and postoperative complications. A total of 418 eyes of 418 patients were included in the analysis with a mean follow-up time of 18.8 (2-62) months. They were classified into a neovascular AMD (n=85) and a dry AMD (n=333) cohort. Mean BCVA improved significantly in the neovascular AMD cohort from 0.69 ±0.45 logMAR to 0.47 ±0.42 (p= <0.001) and in the dry AMD cohort from 0.53 ±0.47 logMAR to 0.27 ±0.32 (p= <0.001) at the two-month follow-up. Improvements in BCVA were sustained to the final visit (18.9 ±19.5 months post-surgery) with BCVA at 0.46 ± 0.38 logMAR (p= <0.001) and 0.26 ± 0.34 logMAR (p= <0.001), respectively. Temporary postoperative increases in CRT and MV were observed, reverting to preoperative levels by six months post-surgery. The need for anti-VEGF therapy did not change postoperatively in patients with neovascular AMD. Within this retrospective analysis, on average patients with coincident AMD of all severity grades meeting the inclusion criteria benefited from cataract surgery. Transient increases in retinal thickness and macular volume returned to baseline within six months post-surgery. The need for intravitreal injections in neovascular AMD subjects was unchanged post-surgery. Overall, the study suggests no adverse long-term macular changes attributable to cataract surgery.