Choroidal Changes after Intravitreal Aflibercept, Faricimab, Brolucizumab, and High-Dose Aflibercept in Treatment-Naïve Neovascular Age-Related Macular Degeneration.

PURPOSE: To compare choroidal structural changes after a loading phase of different anti-VEGF agents in treatment-naïve neovascular age-related macular degeneration (nAMD).

DESIGN

Retrospective, monocentric, observational cohort study.

SUBJECTS: Fifty-six eyes of 56 treatment-naïve patients with nAMD.

METHODS INTERVENTION OR TESTING: Patients received 3 consecutive monthly intravitreal injections of aflibercept 2 mg, aflibercept 8 mg, brolucizumab, or faricimab. Multimodal imaging was performed at baseline and at 3 months using swept-source OCT. Central choroidal thickness (CCT) and choroidal vascularity index (CVI) were quantified. Changes from baseline were analyzed within and between treatment groups, with adjustment for age.

MAIN OUTCOME MEASURES: Change in CCT and CVI after the loading phase.

RESULTS

All treatment groups demonstrated a significant reduction in CCT at 3 months (all P ≤ 0.006). The greatest mean CCT reduction was observed with brolucizumab, followed by aflibercept 8 mg, faricimab, and aflibercept 2 mg. Age-adjusted analysis showed a significant effect of treatment on CCT change, with a significant treatment-by-age interaction (F(3, 48) = 6.24; P = 0.001; η2 = 0.197). Choroidal vascularity index decreased significantly only in the aflibercept 8 mg group (mean change: -4.9; P = 0.01), driven by a preferential reduction in the luminal component (P = 0.002). Brolucizumab predominantly affected the stromal component (P = 0.006) without significant change in CVI.

CONCLUSIONS

Anti-VEGF therapy induces significant choroidal thinning in treatment-naïve nAMD during the loading phase. However, different agents demonstrate distinct choroidal compartmental effects. These findings suggest drug-specific patterns of choroidal remodeling, potentially influenced by molecular and pharmacologic properties, warranting further prospective evaluation to determine their clinical implications.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.