Prechoroidal cleft changes after intravitreal injections of Faricimab in treatment-naïve and nonresponders-to-aflibercept patients: A case series

Abstract

PurposeTo describe the clinical and optical coherence tomography (OCT) changes of prechoroidal cleft in treatment-naïve and non-naïve neovascular age-related macular degeneration (nAMD) treated with Faricimab intravitreal injections.MethodsA case series (4 eyes from 4 patients).ResultsCases 1 and 2 were diagnosed with treatment-naïve nAMD. Case 1 showed minimal prechoroidal cleft persistence after treatment with visual acuity stabilization. Case 2 showed prechoroidal cleft resolution, followed by its recurrence with neovascular reactivation. Cases 3 and 4 had a history of nAMD unresponsive to Aflibercept therapy. In Case 3, prechoroidal cleft reappearance occurred simultaneously to neovascular reactivation. In Case 4 prechoroidal cleft resolved rapidly after switching to Faricimab, but this was complicated by the development of a retinal pigment epithelium (RPE) tear.ConclusionIn this report, we highlight the importance of prechoroidal cleft as a negative prognostic OCT biomarker despite the increasingly proved efficacy of Faricimab. Pigment epithelium detachment height may correlate with the size of prechoroidal cleft and macular neovascularization (MNV) activity. Further studies are needed to better elucidate the prognostic significance of prechoroidal cleft after Faricimab therapy.

Keywords: Faricimab; OCT biomarker; Prechoroidal cleft; neovascular age-related macular degeneration; retinal pigment epithelium detachment.