Abstract
Purpose :
To describe early vascular morphology parameters of choroidal neovascular membranes (CNVMs) seen following switch to intravitreal faricimab in patients with recalcitrant exudative age-related macular degeneration (exAMD).
Methods :
This was a prospective, observational study of CNVMs in recalcitrant AMD. Recalcitrant exAMD was defined as an inability to extend intravitreal Anti-VEGF injections beyond 6 weeks without recurrence of fluid, or persistence of subretinal or intraretinal fluid (SRF/IRF) at 4 weeks with treatment. Swept-source OCT-angiography (OCT-A) (Zeiss/PlexElite 9000) was performed at standard monthly visits during the loading phase of faricimab treatment. CNVMs were segmented using the standardized RPE-RPEfit segmentation on the PlexElite 9000 software on 3x3 and 6x6 mm scans centered on the fovea. Manual adjustments were made if the entire CNVM was not encompassed by this segmentation. Image processing program (FIJI/ImageJ) was used for analysis. The size of the CNVM was manually outlined and subsequently measured by pixel area. Percent change in size of CNVM was then measured and reported. Processed images also obtained average vessel length and vessel density calculations. Statistical analysis was performed using the paired t-test.
Results :
16 eyes of 16 patients (9 female) containing a total of 18 CNVMs (2 patients with two focal CNVMs) are described. The time period between analyzed images ranged from 56-73 days (mean=64). The mean change in size was a decrease of 23.7% (p=.0044). 1 CNVM (5.6%) increased in size >10%, 6 CNVMs (33.3%) changed in size by <10%, and 11 CNVMs (61.1%) decreased in size >10%. Of these 11 CNVMs, 6 CNVMs (54.5%) decreased by greater than 20%. Analysis of change in average vessel length (p=.2497) and change in vessel density (p=.8149) did not reach statistical significance.
Conclusions :
This study demonstrates that there was a statistically significant decrease in size of the CNVM after 2 months, but there were no changes observed for average vessel length and vessel density during the same period. This demonstrates that early vascular morphologic changes do occur in the CNVM vascular patterns evaluated by OCT-A in treatment-recalcitrant exAMD patients switched to faricimab. OCT-A biomarkers may prove to be useful parameters to guide treatment and patient selection as real-world experience with faricimab evolves.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.