Comparison of Choroidal Morphological Changes Between Aflibercept 8 mg and Faricimab-svoa in Treatment-Naïve Polypoidal Choroidal Vasculopathy and Pachychoroid Neovasculopathy

Background/Objectives: This study compared choroidal morphological changes, including choroidal vascularity index (CVI) and layer-specific choroidal thickness, between aflibercept 8 mg and faricimab-svoa in treatment-naïve polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV). Methods: This retrospective study included 66 eyes treated with aflibercept 8 mg (n = 32) or faricimab-svoa (n = 34). Following three monthly loading injections, a pro re nata regimen was employed for 6 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachment (PED) height, and CVI were assessed. Results: Both groups demonstrated significant improvements in BCVA, CMT, SFCT, and PED height at 6 months (all p < 0.05), with no between-group differences. Dry macula rates were 75.0% and 79.4%, respectively. Faricimab-svoa was associated with a significantly greater CVI increase (0.037 vs. 0.018, p = 0.003), driven by a numerically greater reduction in choriocapillaris/Sattler’s layer thickness (−18.9 ± 16.4 μm vs. −13.8 ± 15.8 μm, p = 0.153). Conclusions: Both agents achieved comparable functional and anatomical outcomes in treatment-naïve PCV and PNV. Faricimab-svoa was associated with a greater CVI increase, reflecting differential choroidal remodeling. CVI may serve as a biomarker for differentiating the choroidal effects of second-generation anti-VEGF therapies in pachychoroid spectrum disease.