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<p>Macular neovascularization (MNV) in age-related macular degeneration (AMD) remains a therapeutic challenge, especially in eyes resistant to conventional anti-VEGF therapy. This study evaluates the anatomical and functional response to Faricimab in patients with persistent fluid despite intensified Aflibercept treatment and explores potential benefits of dose escalation. This cross-sectional study included 25 eyes from 23 patients with active MNV resistant to standard anti-VEGF therapy. All had persistent fluid on OCT despite monthly injections and received off-label double-volume Aflibercept 4&#xa0;mg (0.1&#xa0;ml) for at least three doses. Eyes with persistent fluid were switched to Faricimab 6&#xa0;mg. In non-responders, Faricimab was further escalated to 12&#xa0;mg (0.1&#xa0;ml). Retinal fluid volumes and pigment epithelium detachment (PED) were analyzed using AI-based OCT segmentation. MNV activity was assessed using AI-based OCTA analysis. Faricimab 6&#xa0;mg significantly reduced PED volume (<i>p</i> &lt; 0.05), especially after the first two injections. However, changes in intraretinal and subretinal fluid were not significant. In the Faricimab 12&#xa0;mg subgroup, no additional anatomical benefit was observed. OCTA showed a trend toward reduced vascular activity after switching to Faricimab 6&#xa0;mg, but no further change with dose escalation. In MNV eyes resistant to high-dose Aflibercept, Faricimab 6&#xa0;mg provides meaningful anatomical improvement, particularly in PED volume. However, escalating Faricimab to 12&#xa0;mg offers no additional benefit, suggesting therapeutic saturation at the standard dose.</p>

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Faricimab at 6 and 12 mg reduces pigment epithelium detachment in treatment-resistant macular neovascularization: an OCT and AI analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月30日

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  • Ines D. Nagel,
  • Melanie D. Tran,
  • Haochen Zhang,
  • Lingyun Cheng,
  • Anna Heinke,
  • Nehal N. Mehta,
  • Dirk-Uwe Bartsch,
  • Fritz G. P. Kalaw,
  • Mohamed Morsy,
  • Arthur J. Mueller,
  • William R. Freeman

摘要

Macular neovascularization (MNV) in age-related macular degeneration (AMD) remains a therapeutic challenge, especially in eyes resistant to conventional anti-VEGF therapy. This study evaluates the anatomical and functional response to Faricimab in patients with persistent fluid despite intensified Aflibercept treatment and explores potential benefits of dose escalation. This cross-sectional study included 25 eyes from 23 patients with active MNV resistant to standard anti-VEGF therapy. All had persistent fluid on OCT despite monthly injections and received off-label double-volume Aflibercept 4 mg (0.1 ml) for at least three doses. Eyes with persistent fluid were switched to Faricimab 6 mg. In non-responders, Faricimab was further escalated to 12 mg (0.1 ml). Retinal fluid volumes and pigment epithelium detachment (PED) were analyzed using AI-based OCT segmentation. MNV activity was assessed using AI-based OCTA analysis. Faricimab 6 mg significantly reduced PED volume (p < 0.05), especially after the first two injections. However, changes in intraretinal and subretinal fluid were not significant. In the Faricimab 12 mg subgroup, no additional anatomical benefit was observed. OCTA showed a trend toward reduced vascular activity after switching to Faricimab 6 mg, but no further change with dose escalation. In MNV eyes resistant to high-dose Aflibercept, Faricimab 6 mg provides meaningful anatomical improvement, particularly in PED volume. However, escalating Faricimab to 12 mg offers no additional benefit, suggesting therapeutic saturation at the standard dose.