Fong Kenneth C S, Wong Wilson Jun Jie, Wong Hon Seng, Ling Kiet Phang, Fong Shir-Ning, Shunmugam Manoharan
OasisEye Specialists, Kuala Lumpur, Kuala Lumpur, Malaysia.
University of Nottingham Medical School, Nottingham, NG72UH, UK.
Clin Ophthalmol. 2025 Jul 28;19:2475-2485. doi: 10.2147/OPTH.S527787. eCollection 2025.
To present real-world outcomes of switching to faricimab in eyes with polypoidal choroidal vasculopathy (PCV) refractory to previous anti-VEGF treatments.
This retrospective study included PCV eyes switched to faricimab for recurrent PCV (>180 days from prior anti-VEGF treatment), suboptimal extension (60-180 days), or recalcitrant PCV (<60 days). Patients were followed monthly, with PRN reinjections for persistent subretinal fluid (SRF), intraretinal fluid (IRF), or pigment epithelial detachment (PED) at the fovea, or a 1-line vision drop. The primary outcome was time to injection-free status (no injection for 3 months), analyzed via survival analysis.
We included 49 eyes with PCV (mean age 66.1 ± 9.5 years; 59% women), 29% had recurrent PCV, 37% suboptimal extension, and 34% recalcitrant disease. Patients had a median of 8 prior anti-VEGF injections,the majority being aflibercept and received a median of 3 faricimab injections (Interquartile range (IQR)=2-4, range=1-8)) over 344 days (IQR=198-446). The interval between the first two faricimab injections averaged 64 ± 43 days, longer in recurrent (86 ± 55 days) vs recalcitrant PCV (43 ± 26 days, p=0.008). By day 90, 49% were injection-free, increasing to 73% by day 210. PED resolved in 53% after the first dose, and in those needing repeat injections, the interval peaked after the fourth dose with no SRF, IRF, nor PED.
The differential response to faricimab in PCV depends on disease type, with recurrent cases requiring fewer injections and recalcitrant cases requiring more intensive initial treatment; however, even recalcitrant eyes can achieve extended intervals after initial doses.
介绍在先前抗VEGF治疗难治的息肉状脉络膜血管病变（PCV）眼中改用法西单抗的真实世界疗效。
这项回顾性研究纳入了因复发性PCV（距先前抗VEGF治疗>180天）、次优延长（60-180天）或顽固性PCV（<60天）而改用法西单抗的PCV患眼。患者每月随访一次，视情况需要对黄斑中心凹持续性视网膜下液（SRF）、视网膜内液（IRF）或色素上皮脱离（PED），或视力下降1行时进行再次注射。主要结局为无注射状态时间（3个月未注射），通过生存分析进行分析。
我们纳入了49只PCV患眼（平均年龄66.1±9.5岁；59%为女性），其中29%为复发性PCV，37%为次优延长，34%为顽固性疾病。患者先前抗VEGF注射的中位数为8次，大多数为阿柏西普，在344天内接受法西单抗注射的中位数为3次（四分位间距（IQR）=2-4，范围=1-8）。前两次法西单抗注射的间隔平均为64±43天，复发性PCV（86±55天）比顽固性PCV（43±26天）更长（p=0.008）。到第90天，49%的患眼无需注射，到第210天这一比例增至73%。首次给药后53%的PED得到缓解，在需要重复注射的患者中，间隔在第四次给药后达到峰值，此时无SRF、IRF或PED。
PCV对法西单抗的不同反应取决于疾病类型，复发性病例所需注射次数较少，顽固性病例需要更强化的初始治疗；然而，即使是顽固性患眼在初始给药后也能实现更长的间隔时间。
