Abstract
Purpose :
To determine the prevalence of intraretinal and subretinal fluid (IRF, SRF) immediately prior to, and following, switching anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) to Faricimab
Methods :
This is a retrospective analysis of optical coherence tomography (OCT) scans acquired routinely from all eyes undergoing a switch in intravitreal therapy for nAMD from ranibizumab or aflibercept to Faricimab in five Australian retina clinics, between January 1st 2023 and September 30th 2023. The retina specialists followed a treat and extend regimen, with choice of agent at their discretion. OCT scans from each treatment visit were analysed using an automated machine learning algorithm, both for presence/absence of intraretinal and subretinal fluid (IRF, SRF) and change in their volume.
Results :
2685 eyes of 1934 patients treated with either aflibercept or ranibizumab during this period, 640 eyes were treated with Faricimab at least once; 485 of these were switched from another agent. OCT scans were available for all injection visits for all eyes. At the time of switch, 307 eyes (63.3%) had fluid present on OCT. Of these, 45.9%, 33.9% and 14% had SRF alone, IRF alone or both present, respectively (Figure 1 . Subsequently, the lowest proportions of each were achieved at the third injection of Faricimab for SRF and the fourth for IRF or both. The mean volumes of IRF (15nL) and SRF (37nL) were low at time of switch (Figure 2). For those eyes undergoing the most injections, the proportion of eyes with any fluid rose markedly (up to 100%) and the mean volume of SRF more than doubled. The sample size beyond the sixth injection of Faricimab (fifth visit after switch) was much lower.
Conclusions :
Switching anti-VEGF agent to Faricimab was driven by fluid-related treatment failure; the absence of any fluid in approximately one third of all eyes switched suggests that the primary driver for switch in those eyes was extended interval, even in the first nine months of availability of Faricimab in Australia.The rise in proportion of eyes with persistent fluid, as well as the increase in mean fluid volumes is related to the switching of eyes resistant to previous anti-VEGF therapy and the need for more injections in this limited study period when following a treat and extend regimen.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.