Mohan S et al.

, RJMS 2025;15(2):138-141

CASE REPORT

Brolucizumab Monotherapy in Idiopathic Polypoidal Choroidal Vasculopathy:

A Case Report
Mohan S*, Kalpana Badami, Shilpa Y D, Hemalata B C
Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

*Corresponding author:
Mohan S, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka,
India. E-mail: smohanms17224w@gmail.com

Received date: December 22, 2023; Accepted date: August 14, 2024; Published date: April 30, 2025

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0.

Abstract
Brolucizumab, a humanized single-chain antibody fragment targeting VEGF-A, is approved for neovascular
age-related macular degeneration (nAMD) and is being studied for other retinal conditions, including
polypoidal choroidal vasculopathy (PCV). This case report presents a 79-year-old Indian male with idiopathic
PCV in the right eye, characterized by diminished vision and a large serous pigment epithelial detachment
(PED) (1092 μm). He was treated with a pro re nata (PRN) regimen of intravitreal Brolucizumab (6 mg/0.05
ml). After the first injection, PED reduced to 68 μm but later resurfaced (423 μm), requiring a second injection.
Subsequent follow-ups showed fluctuations in fluid levels, necessitating a third injection, after which complete
resolution was observed. This case highlights Brolucizumab’s effectiveness in managing serous PED in IPCV,
with repeated administration improving long-term fluid resolution.
Keywords: Brolucizumab, Idiopathic polypoidal choroidal vasculopathy, Optical coherence tomography,
Serous pigment epithelial detachment

Introduction material into hemorrhagic, fibrovascular, drusenoid,

Polypoidal Choroidal Vasculopathy (PCV) is a subtype and serous types.2 PCV presents distinct features in
of neovascular age-related macular degeneration Indocyanine Green Angiography (ICGA) and Optical
(nAMD), characterized by the dilation of polypoidal Coherence Tomography (OCT) and is frequently
structures and a branching vascular network. This associated with recurrent subretinal hemorrhages and
network is typically located beneath the Retinal Pigment fluid accumulation.3,4 If left untreated, PCV can lead to
Epithelium (RPE) and above Bruch’s membrane.1 permanent vision loss.5
A key factor in vision impairment among patients with The standard treatment for PCV includes intravitreal
age-related macular degeneration (AMD) is Retinal anti-vascular endothelial growth factor (VEGF) agents,
Pigment Epithelium Detachment (PED). PEDs occur either alone or in combination with photodynamic
when the RPE separates from the underlying Bruch’s therapy using verteporfin.3 Brolucizumab, a single-chain
membrane and are classified based on subretinal antibody fragment with a high affinity for VEGF, is one

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Mohan S et
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such agent used in PCV management.6 Its low molecular

weight (26 kDa) allows for higher drug concentration
per injection, potentially leading to prolonged efficacy
and improved tissue penetration.7 These benefits are
attributed to Brolucizumab’s high molar concentration
and small molecular size.8
Studies suggest that Brolucizumab effectively reduces
disease activity, even in cases of treatment-resistant (a) (b)
neovascular AMD.9 However, concerns remain
regarding its safety, including reports of intraocular Figure 1: (a) OCT showed a large serous PED of 1092
inflammation (IOI) and retinal vasculitis, with or without μm, (b) ICG showed juxtafoveal and extrafoveal bunch
of polyps RE with PED
vascular occlusion. Despite these risks, Brolucizumab
has demonstrated favorable functional and anatomical
outcomes in neovascular AMD treatment.10
Case history
A 79-year-old Indian male with a history of hypertension
presented with a two-month history of diminished vision
(DOV) and distortion of vision in his right eye. An initial
ocular examination revealed pseudophakia in both eyes.
The patient had corrected visual acuity of 6/9 in the left
eye and 6/18 in the right eye. Fundus examination of the Figure 2: Post injection (Brolucizumab) after one month
right eye showed bulbous, orange-red lesions protruding OCT showed a greater fluid reduction from 1092 μm to
from the choroid into the subretinal space, characteristic 68 μm
of PCV. In the left eye, a few yellowish lesions were
observed in the paramacular region. Gonioscopy and
intraocular pressure (IOP) were within normal limits.
Optical Coherence Tomography (OCT) of the right eye
revealed a large serous pigment epithelial detachment
(PED) measuring 1092 μm, while Indocyanine Green
Angiography (ICGA) confirmed idiopathic PCV (IPCV) (a) (b)
in the right eye (Figure 1).
Figure 3: (a and b). a. OCT showed resurfacing of serus
Intervention/Treatment regimen PED 423 μm. (b). After 01 month post-second injection
IPCV, observed in the proper ocular organ, was treated (Brolucizumab), OCT showed a reduction of serous
through injections of 6 mg/0.05 ml of Brolucizumab, PED 423 μm to 77 μm
an anti VEGF medication. Brolucizumab injection was
advised in the right eye for IPCV. One month after the
first injection, improvement in DOV was reported. Post
injection, the OCT showed a reduction in serous PED
dimensions from 1092 μm to 68 μm (Figure 2).
A follow-up after one month showed resurfacing of
serous PED measuring 423 μm. Therefore, the patient (a) (b)
was advised for a second injection of Brolucizumab. Figure 4: (a and b) a. OCT showed resurfacing of serus
One month after the second injection, the volume of PED 181 μm. (b). After 01 month post-third injection
serous fluid decreased from 423 μm to 77 μm, as shown (Brolucizumab) OCT showed a complete reduction of
in the OCT (Figure 3a and 3b). serous PED

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Chandrakala G etRJMS 2025;15(2):138-141
al., RJMS 2025;15(1):49-53 Aditya A et al., RJMS 2023;13(4):175-180

The subsequent follow-up OCT showed an increase in Conflict of Interest

fluid volume and serous PED measuring 181 μm. The Nil
patient was then advised to take a third injection. In
the follow-up after the third injection, it was found in
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