Morphometric Changes In Macular Neovascularization Architecture After Faricimab Treatment In Neovascular Age-Related Macular Degeneration: Comparison Between Naïve And Switched Eyes

Purpose: To evaluate the morphometric changes in macular neovascularization (MNV) architecture after faricimab treatment in neovascular age-related macular degeneration (nAMD), comparing treatment-naïve and previously treated eyes. Methods: Prospective study analyzing 45 eyes (18 treatment-naïve, 27 switched) with nAMD undergoing faricimab treatment. Optical coherence tomography angiography (OCTA) images were exported and the quantification of changes in MNV area, vessel area, vessel density, number of junctions, branching index, total vessel length, endpoints, and lacunarity was performed using AngioTool v0.6a. Follow-ups at baseline (V0), end of the loading phase (V1) and at one-year (V2) were collected. Results: Baseline MNV characteristics differed significantly between treatment-naïve 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), endpoint count (p=0.002), and lacunarity (p=0.04). Conversely, naïve eyes had higher vessel density (p<0.001) and branching index (p=0.007). Post-treatment, MNV area (p<0.001), vessel area (p<0.001), junction count (p=0.001) and total vessel length (p<0.001) decreased, while lacunarity increased (p=0.001). Greater changes were observed in naïve eyes, but the endpoint count only reduced in switched eyes (p=0.01), being stable in naïve 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 endpoints (p=0.007). Conclusion: Faricimab induces significant and sustained remodeling of the MNV network in nAMD, with more pronounced changes in treatment-naïve eyes. These changes were primarily driven by the loading phase, but then remained stable toward the one-year follow-up.