Aflibercept 8mg for neovascular age related macular degeneration refractory to faricimab

PURPOSE: To evaluate the short-term efficacy of intravitreal aflibercept 8 mg in patients with neovascular age-related macular degeneration (nAMD) who exhibited persistent or recurrent exudation two months after faricimab treatment during the maintenance phase following anti-vascular endothelial growth factor (VEGF) loading therapy. STUDY DESIGN: Retrospective observational study. METHODS: Twenty-seven eyes with nAMD were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) biomarkers-including intraretinal fluid (IRF), subretinal fluid (SRF), and sub-retinal pigment epithelium (sub-RPE) fluid at the subfoveal and macular areas-were evaluated before and two months after treatment with faricimab and aflibercept 8 mg. Subgroup analyses were performed according to AMD subtype (typical nAMD vs. polypoidal choroidal vasculopathy [PCV]) and pachychoroid characteristics (pachychoroid vs. non-pachychoroid). RESULTS: BCVA did not show significant changes after either faricimab or aflibercept 8 mg treatment. However, aflibercept 8 mg resulted in a significant reduction in subfoveal SRF (from 44.4% to 11.1%, P = 0.014) and macular SRF (from 85.2% to 29.6%, P < 0.0001), whereas faricimab did not produce significant anatomical improvements. No significant changes were observed in IRF or sub-RPE fluid with either treatment, possibly due to the low prevalence of the fluid at baseline. Subgroup analyses demonstrated no substantial differences in treatment response between typical nAMD and PCV, or between pachychoroid and non-pachychoroid eyes. CONCLUSION: Intravitreal aflibercept 8 mg may provide short-term anatomical benefits, particularly in reducing subretinal fluid, in eyes with nAMD showing persistent or recurrent exudation after faricimab treatment during the maintenance phase, regardless of nAMD subtype or pachychoroid status.