法西单抗治疗新生血管性年龄相关性黄斑变性（nAMD）中耐药性脉络膜新生血管（CNV）：使用人工智能和光学相干断层扫描血管造影（OCTA）的7个月结果
Faricimab for treatment-resistant choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD): seven-months results using artificial intelligence and OCTA.
作者信息
Heinke Anna, Warter Alexandra, Nagel Ines D, Agnihotri Akshay, Mehta Nehal Nailesh, Galang Carlo Miguel B, Deussen Daniel N, Bartsch Dirk-Uwe G, Cheng Lingyun, Ferreyra Henry A, Freeman William R
机构信息
Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92037, USA.
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92037, USA.
出版信息
Int J Retina Vitreous. 2025 Jun 17;11(1):68. doi: 10.1186/s40942-025-00691-4.
BACKGROUND
To analyze the therapeutic response to faricimab 6 mg/0.05 ml in eyes with neovascular AMD (nAMD) with refractory intra- and/or subretinal fluid due to choroidal neovascularization (CNV), previously unresponsive to 4 mg monthly aflibercept and combination therapy with anti-VEGF and long-acting steroids.
METHODS
A retrospective case series study of 22 eyes with unresponsive CNV, despite monthly intravitreal treatment (mean number of pre-faricimab injections: 35.52 ± 17.12). We evaluated therapeutic response in eyes with persistent intra/subretinal fluid (IRF/SRF) unresponsive to anti-VEGF double-dose (DD) monotherapy (4-mg aflibercept) and/or simultaneous DD anti-VEGF (4-mg aflibercept) with steroids (triamcinolone). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and optical coherence tomography (OCT) measurements of central retinal thickness (CRT) were recorded for 7 follow-ups. Baseline and follow-up OCTs were examined by an AI-developed platform (Discovery OCT Fluid and Biomarker Detector, RetinAI AG, Switzerland) to measure the volume of IRF, SRF, and pigment epithelium detachment (PED) in nanoliters (nL) and CRT in micrometers (μm). Paired t-test compared these parameters at baseline and after treatment. OCTA analysis of CNV before and after treatment with faricimab was conducted using Angio-Tool software.
RESULTS
Anatomic outcomes included mean CRT reduction of -25.3 μm (p = 0.0118) at month-1, -16.15 μm (p = 0.0414) at month-4, and -26.36 μm (p = 0.0129) after the 7th follow-up. AI-assisted software analysis showed a significant reduction of IRF, SRF, and PED volume at multiple time points after initiating faricimab. There was a non-significant improvement in BCVA.
CONCLUSIONS
Switching to faricimab improved anatomy in highly treatment-resistant CNV eyes, indicating its potential when other therapeutic options have failed.
背景
分析6mg/0.05ml的法西单抗对患有新生血管性年龄相关性黄斑变性（nAMD）且因脉络膜新生血管（CNV）导致难治性视网膜内和/或视网膜下液的眼睛的治疗反应，这些眼睛之前对每月4mg阿柏西普以及抗血管内皮生长因子（VEGF）与长效类固醇的联合治疗无反应。
方法
一项对22只对CNV无反应的眼睛进行的回顾性病例系列研究，尽管进行了每月一次的玻璃体腔内治疗（法西单抗注射前的平均次数：35.52±17.12）。我们评估了对双剂量（DD）抗VEGF单药治疗（4mg阿柏西普）和/或同时使用DD抗VEGF（4mg阿柏西普）与类固醇（曲安奈德）无反应的持续性视网膜内/视网膜下液（IRF/SRF）患者的治疗反应。记录了7次随访的最佳矫正视力（BCVA）、眼压（IOP）和光学相干断层扫描（OCT）测量的中心视网膜厚度（CRT）。通过人工智能开发的平台（Discovery OCT Fluid and Biomarker Detector，RetinAI AG，瑞士）检查基线和随访的OCT，以测量IRF、SRF和色素上皮脱离（PED）的体积（以纳升（nL）为单位）以及CRT（以微米（μm）为单位）。配对t检验比较了这些参数在基线和治疗后的情况。使用Angio-Tool软件对法西单抗治疗前后的CNV进行OCTA分析。
结果
解剖学结果包括第1个月时CRT平均降低-25.3μm（p = 0.0118），第4个月时降低-16.15μm（p = 0.0414），第7次随访后降低-26.36μm（p = 0.0129）。人工智能辅助软件分析显示，开始使用法西单抗后的多个时间点，IRF、SRF和PED体积均显著减少。BCVA有不显著的改善。
结论
改用 法西单抗可改善对治疗高度抵抗的CNV眼睛的解剖结构，表明在其他治疗选择失败时它具有潜力。
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