REDUCTION OF CHOROIDAL THICKNESS AND CHOROIDAL VASCULARITY INDEX BY FARICIMAB COMPARED WITH RANIBIZUMAB AND AFLIBERCEPT IN POLYPOIDAL CHOROIDAL VASCULOPATHY AND PACHYCHOROID NEOVASCULOPATHY.

PURPOSE: To evaluate outcomes of intravitreal faricimab in polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV), focusing on subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI), compared with ranibizumab and aflibercept.

METHODS: This retrospective cohort study included 96 treatment-naive eyes with PCV or PNV, allocated by 1:1:1 propensity score matching to receive three consecutive monthly intravitreal injections of faricimab, ranibizumab, or aflibercept (n = 32 each). Best-corrected visual acuity (BCVA), central macular thickness (CMT), SFCT, and the CVI were evaluated at baseline and at Months 1 to 3. In addition, total choroidal area (TCA), luminal area (LA), and stromal area (SA) were quantified.

RESULTS: Baseline characteristics were similar. Best-corrected visual acuity and CMT changes were not significantly different. Faricimab induced greater SFCT reduction than ranibizumab ( P < 0.001 at Months 1-3) and aflibercept ( P = 0.029, 0.005, 0.004 at Months 1-3). Choroidal vascularity index reduction was also greater with faricimab than ranibizumab ( P = 0.001, <0.001, 0.010 at Months 1-3) and aflibercept ( P = 0.032, 0.024 at Months 2-3). This was driven by larger LA reduction relative to TCA and SA (LA vs. TCA: P < 0.001 at Months 1-2, P = 0.006 at Month 3; LA vs. SA: P < 0.001 at Months 1-3). Ranibizumab and aflibercept showed proportional decreases without significant differences.

CONCLUSION: Faricimab achieved greater SFCT and CVI reductions, suggesting enhanced vascular stabilization and reduced pachyvessel congestion. These results support the therapeutic potential of dual vascular endothelial growth factor-A/angiopoietin-2 inhibition in PCV and PNV.