Outcomes and predictive factors for fluid resolution following three loading injections of faricimab for treatment-naïve neovascular age-related macular degeneration

Abstract

To evaluate the outcomes and predictive factors for fluid resolution following three loading injections of faricimab for neovascular age-related macular degeneration(AMD). This retrospective study included patients diagnosed with treatment-naïve neovascular AMD who received three monthly injections of faricimab. Changes in best-corrected visual acuity(BCVA) and central retinal thickness(CRT) following treatment were evaluated. The resolution of subretinal fluid(SRF), intraretinal fluid(IRF), and serous pigment epithelial detachment(PED) was also assessed. In addition, factors associated with complete resolution of SRF and IRF were investigated. A total of 69 patients were included in this study. BCVA significantly improved from a mean logarithm of minimal angle of resolution of 0.64 ± 0.41 at baseline to 0.47 ± 0.39 at 3 months (P < 0.001). CRT significantly decreased from 424.1 ± 155.5 μm at baseline to 266.3 ± 71.7 μm at 3 months (P < 0.001). At baseline, SRF was observed in 55 eyes (79.7%), IRF in 39 eyes(56.5%), and serous PED in 57 eyes(82.6%). By 3 months, the number of eyes showing these findings had decreased to 11 eyes(15.9%) for SRF, 6 eyes(8.7%) for IRF, and 10 eyes(14.5%) for serous PED. The presence of type 2 (88.2%) and type 3 (94.7%) macular neovascularization(MNV) was associated with a high incidence of complete resolution of SRF and IRF after treatment. Three loading injections of faricimab resulted in significant functional and anatomical improvements in treatment-naïve neovascular AMD, with a high rate of resolution of SRF, IRF, and serous PED. The anatomical effects were especially pronounced in cases of type 2 and type 3 MNV.

Keywords: Age-related macular degeneration; Choroidal neovascularization; Faricimab; Macular neovascularization.

Fig. 1

Changes in (A) BCVA and (B) CRT after three loading injections of faricimab (3 months). BCVA was significantly improved (P < 0.001), and CRT significantly decreased (P < 0.001) after treatment. Statistical analysis was performed using paired t-tests. An asterisk indicates a statistically significant difference compared to the baseline value. BCVA, best corrected visual acuity; CRT, central retinal thickness; logMAR, logarithm of minimum angle of resolution.

Fig. 2

Changes in the proportion of eyes with pathological findings on optical coherence tomography. (A) Changes in the proportion of eyes with SRF, IRF, and serous PED before and after three loading injections (n = 69). (B) Changes in the proportion of each fluid compartment over the follow-up period (n = 53). IRF, intraretinal fluid; PED, pigment epithelial detachment; SRF, subretinal fluid.

Fig. 3

Representative cases demonstrating the clinical outcomes of three loading injections of faricimab. (A–C) A 76-year-old patient initially presented with type 2 MNV and received faricimab treatment. (A) At diagnosis, OCT revealed IRF (asterisk) and serous PED (arrowheads). (B) One month after the first injection, complete resolution of IRF and serous PED was observed. (C) The macula remained dry at 3 months. (D–F) A 77-year-old patient initially presented with type 3 MNV and received faricimab treatment. (D) At diagnosis, OCT revealed IRF (asterisk), SRF (arrow), and serous PED (arrowhead). (E) One month after the first injection, complete resolution of IRF and SRF was observed, along with a marked decrease in serous PED. (F) The macula remained dry at 3 months, with complete resolution of serous PED. IRF, intraretinal fluid; MNV, macular neovascularization; OCT, optical coherence tomography; PED, pigment epithelial detachment; SRF, subretinal fluid.

Fig. 4

A Kaplan–Meier graph depicting the cumulative incidence of complete resolution of both SRF and IRF, stratified by MNV type. IRF, intraretinal fluid; MNV, macular neovascularization; SRF, subretinal fluid. The log-rank test revealed no significant difference in complete fluid resolution among the different types of MNV (P = 0.100).