Anatomic and functional outcomes of intravitreal faricimab for polypoidal choroidal vasculopathy: a review

This review examines anatomic and functional outcomes of intravitreal faricimab for treating polypoidal choroidal vasculopathy (PCV), a neovascular age-related macular degeneration subtype common in Asian populations. Faricimab is a bispecific antibody targeting both VEGF-A and Ang-2, potentially offering more durable effects than standard anti-VEGF monotherapy.

A narrative review was conducted by searching PubMed, Embase, and Web of Science through July 2024. Keywords included faricimab, polypoidal choroidal vasculopathy, and anti-VEGF. Eligible studies comprised English-language, peer-reviewed human trials (prospective, retrospective, case series, and reports). Conference abstracts and non-peer-reviewed sources were excluded.

In treatment-naïve patients, preliminary data suggest that faricimab may yield favorable results, though findings are largely derived from small retrospective studies. Functionally, a one-year study reported significant improvement in mean best-corrected visual acuity (BCVA), from 0.30±0.33 logMAR at baseline to 0.16±0.26 logMAR at final visit. However, some studies note visual gains may not be statistically significant during initial loading phase. Anatomically, high polyp regression rates are key findings, with one study reporting 61.1% rate after three monthly injections. High rates of dry macula (60-80%) and significant reductions in central foveal thickness (CFT) and central choroidal thickness (CCT) are consistently observed. For patients with suboptimal response to prior anti-VEGF therapies, switching to faricimab presents mixed picture. While a prospective cohort study found no significant average improvement in visual acuity for switched PCV eyes, a case report showed dramatic improvement from 20/100 to 20/60 after two injections in a ranibizumab-refractory case. Anatomically, switched patients show significant reduction in choroidal thickness and serous pigment epithelial detachments (PEDs). However, the presence of polypoidal lesions was identified as a negative predictive factor for successfully extending the treatment interval.

Based on limited retrospective evidence, faricimab may represent a promising therapeutic candidate for PCV, with several studies reporting anatomical improvements. The dual mechanism of action targeting both VEGF-A and Ang-2 may help address certain pathological features of the disease; however, confirmation from larger prospective studies is needed.