Abstract
Purpose :
To describe early pigment epithelial detachment (PED) changes seen following switch to intravitreal faricimab in patients with recalcitrant exudative age-related macular degeneration (exAMD).
Methods :
This was a retrospective, observational study of PEDs in recalcitrant exAMD. 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 Optical Coherence Tomography (OCT) (Zeiss/PlexElite 9000) was performed at standard monthly visits during the loading phase of faricimab treatment. 6x6 mm scans centered on the fovea were collected immediately before administration of the 1st and 4th dose of intravitreal faricimab. Patients were excluded if they had subretinal bleeding, history of photodynamic therapy (PDT), or if the neovascular membrane was not completely encompassed in a 6x6 mm scan. PED areas and volumes were automatically outlined and calculated using the manufacturer’s software algorithm. Average and maximum PED height were also calculated automatically for the same images. Percent change in PED volume, area, and height characteristics were reported. Statistical analysis was performed using the paired t-test.
Results :
Nineteen eyes of eighteen patients (8 female) are described. The time period between analyzed images ranged from 84-112 days (mean=94). Fourteen eyes were most recently injected with aflibercept, while five eyes were most recently injected with ranibizumab. The mean change in PED volume was a 26% decrease (P<.01). Mean and maximum PED heights were significantly decreased at the 4th visit (p<.01 and p=.02, respectively). No statistically significant changes were observed for PED area.
Conclusions :
Large changes in PED characteristics are observed throughout the loading phase of faricimab in treatment recalcitrant exAMD patients. PED characteristics may serve as useful biomarkers to guide faricimab treatment intervals in patients with exAMD. Future direction will involve correlating these significant anatomic changes to visual parameters.
This abstract was presented at the 2023 ARVO Imaging in the Eye Conference, held in New Orleans, LA, April 21-22, 2023.