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Introduction <p>Polypoidal choroidal vasculopathy (PCV) is a major subtype of neovascular age-related macular degeneration (nAMD), particularly prevalent in Asian and pigmented populations. While anti-vascular endothelial growth factor (anti-VEGF) therapy has improved outcomes, limitations in durability and incomplete polypoidal lesion regression remain. This review provides an updated synthesis of emerging evidence on newer anti-VEGF agents in PCV management.</p> Methods <p>This narrative review synthesizes recent evidence in PCV management, integrating data from clinical trials and emerging real-world studies, with a focus on newer anti-VEGF agents including faricimab (Vabysmo, Roche/Genentech)and aflibercept 8&#xa0;mg (Eylea HD, Regeneron).</p> Results <p>Faricimab, a bispecific antibody targeting VEGFA and angiopoietin-2 (Ang-2), demonstrated non-inferior efficacy compared with aflibercept 2&#xa0;mg administered every 8&#xa0;weeks in the TENAYA/LUCERNE trials, with over 70% of patients achieving dosing intervals of ≥ 12&#xa0;weeks. The SALWEEN study further evaluated faricimab in 135 patients with PCV, reporting robust visual gains (+ 8.9 letters), 61% polypoidal lesion regression, and over 80% of patients achieving ≥ 12-week dosing intervals at 48&#xa0;weeks. Aflibercept 8&#xa0;mg, evaluated in the PULSAR trial, demonstrated comparable safety and efficacy with improved anatomical drying and extended dosing intervals (12–16&#xa0;weeks) compared with aflibercept 2&#xa0;mg. In a subgroup analysis of 139 eyes with indocyanine green angiography (ICGA)-confirmed PCV, outcomes were consistent with the overall study population, with similar visual and anatomical improvements but reduced injection burden. More than 80% of eyes achieved dosing intervals of ≥ 12&#xa0;weeks at 2&#xa0;years.</p> Conclusions <p>Faricimab and aflibercept 8&#xa0;mg represent important advances in PCV management, offering more durable treatment options and reducing treatment burden. However, important gaps remain, including limited real-world data for aflibercept 8&#xa0;mg, absence of head-to-head PCV-specific trials, and uncertainty regarding long-term recurrence and lesion inactivation. These findings support a shift toward increasingly individualized and durable treatment strategies in PCV.</p>

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Advances in Polypoidal Choroidal Vasculopathy (PCV) Management: Emerging Evidence for Faricimab and Aflibercept 8 mg

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • Mohamed Zakaria Sherif,
  • Kelvin Y. C. Teo,
  • Timothy Y. Y. Lai,
  • Hiok Hong Chan,
  • Beau J. Fenner,
  • Won Ki Lee,
  • Chui Ming Gemmy Cheung

摘要

Introduction

Polypoidal choroidal vasculopathy (PCV) is a major subtype of neovascular age-related macular degeneration (nAMD), particularly prevalent in Asian and pigmented populations. While anti-vascular endothelial growth factor (anti-VEGF) therapy has improved outcomes, limitations in durability and incomplete polypoidal lesion regression remain. This review provides an updated synthesis of emerging evidence on newer anti-VEGF agents in PCV management.

Methods

This narrative review synthesizes recent evidence in PCV management, integrating data from clinical trials and emerging real-world studies, with a focus on newer anti-VEGF agents including faricimab (Vabysmo, Roche/Genentech)and aflibercept 8 mg (Eylea HD, Regeneron).

Results

Faricimab, a bispecific antibody targeting VEGFA and angiopoietin-2 (Ang-2), demonstrated non-inferior efficacy compared with aflibercept 2 mg administered every 8 weeks in the TENAYA/LUCERNE trials, with over 70% of patients achieving dosing intervals of ≥ 12 weeks. The SALWEEN study further evaluated faricimab in 135 patients with PCV, reporting robust visual gains (+ 8.9 letters), 61% polypoidal lesion regression, and over 80% of patients achieving ≥ 12-week dosing intervals at 48 weeks. Aflibercept 8 mg, evaluated in the PULSAR trial, demonstrated comparable safety and efficacy with improved anatomical drying and extended dosing intervals (12–16 weeks) compared with aflibercept 2 mg. In a subgroup analysis of 139 eyes with indocyanine green angiography (ICGA)-confirmed PCV, outcomes were consistent with the overall study population, with similar visual and anatomical improvements but reduced injection burden. More than 80% of eyes achieved dosing intervals of ≥ 12 weeks at 2 years.

Conclusions

Faricimab and aflibercept 8 mg represent important advances in PCV management, offering more durable treatment options and reducing treatment burden. However, important gaps remain, including limited real-world data for aflibercept 8 mg, absence of head-to-head PCV-specific trials, and uncertainty regarding long-term recurrence and lesion inactivation. These findings support a shift toward increasingly individualized and durable treatment strategies in PCV.