Abstract
Purpose :
To describe change in macular neovascular membrane (MNV) area in recalcitrant eyes after 1 year of intravitreal faricimab for exudative age-related macular degeneration (exAMD).
Methods :
This is a retrospective observational case-series of recalcitrant exAMD eyes 1 year after transitioning to intravitreal faricimab. Recalcitrant eyes were defined as eyes previously treated with anti-VEGF agents, unable to be extended past 4-week treatment intervals. Eyes were evaluated with 6x6mm swept-source optical coherence tomography angiography (SS-OCTA; Zeiss/PlexElite 9000) scans before the first faricimab injection and at defined intervals during treatment. Scans were segmented using the device's automatic “RPE-RPEfit” software with manual adjustments to ensure the entire MNV was encompassed. MNV areas were manually outlined at the edges of vascular signals. If multiple discrete MNVs were present, they were analyzed separately (FIJI/ImageJ). MNV area percent change from baseline to 1 year was evaluated. Snellen BCVA from chart review was converted to logMAR to evaluate the mean difference between baseline and 1 year. Statistical analysis was performed using two-tailed paired t-test.
Results :
Twenty recalcitrant eyes of 18 patients (13 female) with 24 MNVs (3 eyes with multiple MNVs), were evaluated. Days between baseline to 1 year visits averaged 369 days (range 329-404). The average injection interval at 1 year was 7.1 weeks (range 4-12). After 1 year of faricimab treatment, the mean difference in MNV area was a decrease of 28.7% (p=0.015). Of 24 MNVs evaluated, 5 increased in area, 4 decreased by < 25%, 7 decreased by 25-50%, 7 decreased by 50-75%, and 1 decreased in area by >75%. Vision remained stable with logMAR mean difference=0.004 (p=0.74).
Conclusions :
In recalcitrant exAMD eyes, there was a significant decrease in MNV area after 1 year of optimized faricimab treatment. Injection intervals were able to be extended up to 12-weeks while maintaining stable vision, demonstrating consistent morphologic changes in the MNV vascular patterns evaluated by OCT-A. We hope these OCT-A metrics have future use as biomarkers to monitor response to faricimab in this population.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.