Comparison of Choroidal Morphological Changes Between Aflibercept 8 mg and Faricimab-svoa in Treatment-Naïve Polypoidal Choroidal Vasculopathy and Pachychoroid Neovasculopathy.

Background/

Objectives

This study compared choroidal morphological changes, including choroidal vascularity index (CVI) and layer-specific choroidal thickness, between aflibercept 8 mg and faricimab-svoa in treatment-naïve polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV).

Methods

This retrospective study included 66 eyes treated with aflibercept 8 mg (n = 32) or faricimab-svoa (n = 34). Following three monthly loading injections, a pro re nata regimen was employed for 6 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachment (PED) height, and CVI were assessed.

Results

Both groups demonstrated significant improvements in BCVA, CMT, SFCT, and PED height at 6 months (all p < 0.05), with no between-group differences. Dry macula rates were 75.0% and 79.4%, respectively. Faricimab-svoa was associated with a significantly greater CVI increase (0.037 vs. 0.018, p = 0.003), driven by a numerically greater reduction in choriocapillaris/Sattler's layer thickness (-18.9 ± 16.4 μm vs. -13.8 ± 15.8 μm, p = 0.153).

Conclusions

Both agents achieved comparable functional and anatomical outcomes in treatment-naïve PCV and PNV. Faricimab-svoa was associated with a greater CVI increase, reflecting differential choroidal remodeling. CVI may serve as a biomarker for differentiating the choroidal effects of second-generation anti-VEGF therapies in pachychoroid spectrum disease.