Vascular remodeling of macular neovascularization following switch to intravitreal faricimab in neovascular AMD

Purpose: To describe qualitative optical coherence tomography angiography (OCTA) changes in age-related macular degeneration (AMD) macular neovascularization (MNV) treated with faricimab. Methods: This was a retrospective study including 30 eyes with active AMD-related Type 1 MNV, resistant to traditional anti-vascular endothelial growth factor (VEGF) agents, receiving intravitreal faricimab. Complete ophthalmological evaluation, consisting of best corrected visual acuity (BCVA), traditional multimodal imaging, and OCTA scans, was performed at baseline and at the last examination. OCTA high-flow networks corresponding to MNV were qualitatively and quantitatively analyzed to assess morphological changes. Furthermore, the correlation between MNV OCTA pattern and presence/absence of exudation signs on spectral domain OCT (SD-OCT) was evaluated. Results: On baseline OCTA, 11/30 eyes showed a sea fan pattern, 13/30 a medusa pattern, and the remaining 6/30 an indistinct pattern. At the last follow-up, in 12/30 eyes, the MNV pattern remained unchanged. In these 12 cases, SD-OCT revealed the exudative signs in 11/12 eyes (one with intra-retinal fluid, ten with sub-retinal fluid) at the final evaluation. In the remaining 18/30, MNV pattern changed to a dead tree type with no exudation signs at the last follow-up in 17/18 eyes. The mean interval of intravitreal injection was significantly extended from 4 to 7.2±2.3 weeks (p < 0.0001) with BCVA stabilization. At the last follow-up the dead tree OCTA pattern resulted to be significantly related to the absence of exudation sings (p < 0.0001). Conclusion: Our study reveals that the initial MNV pattern frequently moves toward a dead tree pattern after switching from traditional anti-VEGF agents to faricimab therapy.