MORPHOMETRIC CHANGES IN MACULAR NEOVASCULARIZATION ARCHITECTURE AFTER FARICIMAB TREATMENT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Comparison Between Naive and Switched Eyes.

Abstract

To evaluate the morphometric changes in macular neovascularization (MNV) architecture after faricimab treatment in neovascular age-related macular degeneration, comparing treatment-naive and previously treated eyes. Prospective study analyzing 45 eyes (18 treatment naive, 27 switched) with neovascular age-related macular degeneration undergoing faricimab treatment. Optical coherence tomography angiography images were exported and the quantification of changes in MNV area, vessel area, vessel density, number of junctions, branching index, total vessel length, end points, and lacunarity was performed using AngioTool v0.6a. Follow-ups at baseline (V0), at the end of the loading phase (V1), and at 1 year (V2) were collected. Baseline MNV characteristics differed significantly between treatment-naive and switched eyes. Switched eyes exhibited greater MNV area ( P < 0.001), vessel area ( P < 0.001), junction count ( P = 0.004), vessel length ( P < 0.001), average vessel length ( P = 0.02), end point count ( P = 0.002), and lacunarity ( P = 0.04). Conversely, naive eyes had higher vessel density ( P < 0.001) and branching index ( P = 0.007). Posttreatment, MNV area ( P < 0.001), vessel area ( P < 0.001), junction count ( P = 0.001), and total vessel length ( P < 0.001) decreased, whereas lacunarity increased ( P = 0.001). Greater changes were observed in naive eyes, but the end point count only reduced in switched eyes ( P = 0.01), being stable in naive eyes. At V2, switched eyes still had larger MNV area ( P = 0.007), vessel area ( P = 0.004), junction count ( P = 0.002), vessel length ( P = 0.004), and end points ( P = 0.007). Faricimab induces significant and sustained remodeling of the MNV network in neovascular age-related macular degeneration, with more pronounced changes in treatment-naive eyes. These changes were primarily driven by the loading phase, but then remained stable toward the 1-year follow-up.