Long-Term Follow-Up of Faricimab Intravitreal Injections in Naïve Neovascular Age-Related Macular Degeneration

Early anatomical outcomes of faricimab vs aflibercept 2 mg in treatment-naïve neovascular age-related macular degeneration and polypoidal choroidal vasculopathy: A head-to-head comparative study in Taiwan

To evaluate the efficacy of intravitreal injection of bevacizumab (IVB) followed by modified grid laser photocoagulation (MGP) versus each alone as a primary treatment of diffuse diabetic macular edema. A randomized 3-arm clinical trial in which 62 eyes of 48 patients with diffuse diabetic macular edema were enrolled. Eyes were randomly distributed to 1 of 3 study groups: 19 eyes underwent MGP (MGP group), 21 eyes received 1.25 mg of IVB (IVB group), and 22 eyes received IVB followed by MGP (combined group). All eyes underwent a complete ophthalmic examination including fluorescein angiography and optical coherence tomography at baseline and at 1, 3, and 6 months, after treatment. Fluorescein angiography was performed at the 3 and 6 months follow up visits. The outcome measures were the change compared with baseline in central macular thickness (CMT), changes in best-corrected visual acuity (BCVA), changes in fluorescein angiography leakage, and any reported complication. A P value less than 0.05 was considered statistically significant. One month after treatment, the reduction in the mean CMT versus baseline was 49.88 μm (10.45%) in MGP group, 150.92 μm (31.30%) in IVB group, and 110.30 μm (23.77%) in the combined group, with a corresponding improvement in the mean BCVA. At 1 month, the improvement in CMT was better than baseline in all groups, yet only significant in the IVB group (P < 0.05) and the combined group (P < 0.05). The improvement in mean BCVA was significant in the IVB (P < 0.05) and the combined groups at 1 month (P < 0.05). At 3 months, the mean CMT was still better than baseline in all groups but this improvement was significant only in the combined group (P < 0.05). The improvement in the mean BCVA was significant only in the IVB and the combined groups (P < 0.05). Six months after treatment, the reduction in the mean CMT was significant in the combined group only (P < 0.05) and there was no significant improvement in the mean BCVA in all groups (P > 0.05). The BCVA did not deteriorate below baseline in all eyes included in the study, except three eyes in the MGP group. No complication related to the intravitreal injection was reported in the injected eyes. Combined therapy with IVB and sequential MGP 3 weeks later appeared to be superior to MGP or IVB alone in reducing macular thickening and improving visual acuity. However, no significant improvement in BCVA occurs 6 months after treatment. A combination of IVB and sequential MGP could be used as an initial treatment of diffuse diabetic macular edema.

PurposeTo compare visual and anatomical outcomes of intravitreal injections of bevacizumab and dexamethasone implant (Ozurdex) treatment for macular edema associated with branch retinal vein occlusion (BRVO).MethodsWe retrospectively reviewed patients who underwent intravitreal bevacizumab administered monthly on a pro re nata (PRN) basis (26 eyes, IVB group) or an initial 700-µg dexamethasone implant followed by a bevacizumab PRN injection (20 eyes, IVD group) for treatment of macular edema associated with BRVO. We compared best-corrected visual acuity (BCVA) and central macular thickness (CMT). We also measured ellipsoid zone recovery rate and ganglion cell-inner plexiform layer volume within the center 6 mm zone. A linear mixed model analysis was performed to compare serial changes in BCVA and CMT.ResultsBoth groups showed significant improvement in BCVA and significant reduction in CMT. However, BCVA in the first month was significantly better in the IVD group (logarithm of the minimum angle of resolution, IVD group 0.21 ± 0.26 vs. IVB group 0.39 ± 0.30, p = 0.038) and the 1-month CMT was thinner in the IVD group (IVD group 270.0 ± 62.0 µm vs. IVB group 338.9 ± 122.6 µm, p = 0.028), and these trends were maintained during the 6-month follow-up. The IVD group showed more rapid macular edema resolution (p = 0.049); however, there were no significant differences in ellipsoid zone recovery rate (p = 0.268) or ganglion cell-inner plexiform layer volume between the two groups (p = 0.459).ConclusionsThere were no significant differences in final visual or anatomical outcomes between the two groups; however, initial dexamethasone implant injection followed by bevacizumab PRN injection initially showed more rapid improvement in vision and BRVO-associated macular edema resolution compared to intravitreal bevacizumab administered monthly on a PRN basis.

Objective To compare the efficiency ofintravitreal injection oftriamcinolone acetonide or bevacizumab for the treatment ofmaeular edema in retinal vein occlusion. Methods One hundred and sixteen eyes of 116 patients with macular edema of retinal vein occlusion were diagnosed by examination of regular inspection, fundus fluorescein angiography (FFA) and optic coherence tomography (OCT). There were 75 patients in TA group and 41 patients in bevacizumab group. One hundred and sixteen patients received intravitreal injection of either 4mg/0. 1ml of triamcinolone acetonide or 1.25mg/0.05ml of bevacizumab. There were no significant differences between the two groups with regards to patients' age, duration of disease, best-corrected visual acuity (BCVA), central macular thickness (CMT) at baseline. Comprehensive ophthalmic evaluation was performed at baseline and at weeks 4, 8 and 12 after treatment. Main outcome measures included CMT measured with OCT and BCVA. Results Separate within-group analysis of showed significant improvement in BCVA from baseline in TA group at weeks 4 (P=0.000)、8 (P=0.000)、12 (P=0.000), and at weeks 4 (P=0.000), 8 (P=0.000) in bevacizumab group. The results showed significant reduction in CMT in TA group at weeks 4(P=0.000), 8(P=0.000), 12(P=0.004), and at weeks 4(P=0.003), 8(P=0.000) in bevacizumab group. But no significant interaction between groups were observed for BCVA at weeks 4(P=0.985), 8(P=0.989), 12(P=0.306) and for CMT at weeks 4(P=0.075), 8(P=0.453), 12(P=0.583). There was a significant increase in IOP in the TA group when compared with the bevacizumab group. Conclusion The result in our observation showed that intravitreai injection of either triamcinolone acetonide or bevacizumab was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with retinal vein occlusion. A randomly controlled multi-center clinical triai is necessary. Key words: Bevacizumab; Triamcinolone acetonide; Macular edema; Retinal vein occlusion

Introduction: The aim of the study was to evaluate functional and anatomical changes in patients with neovascular age-related macular degeneration (nAMD) treated with a loading dose of faricimab intravitreal injections (IVIs). Methods: Eighteen eyes of 18 patients with active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University G. D’Annunzio, Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI as per label. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All measurements were evaluated at baseline (T0) and then monthly up to week 20 (T4). Main outcome measures were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachments (PEDs) presence and maximum height (PED-MH), intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and thickness. Results: BCVA improved and CMT reduced significantly during follow-up (p < 0.001). In addition, SFCT decreased significantly (p = 0.031). Between T0 and T4, SSRF presence reduced from 55.6 to 16.7% (p = 0.045); IRF presence changed from 50 to 22.2%, respectively (p = 0.074). PED-MH was reduced in 58.8% of patients at T4. At week 20, 72.3% of patients were in the q12/q16 interval. Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of anatomical and functional parameters and a treatment interval after the loading phase equal or greater than 12 weeks in the majority of patients.

Purpose Aflibercept 8 mg is a newly developed option for neovascular age-related macular degeneration (nAMD) class. This study explores the short-term effectiveness of aflibercept 8 mg in patients with refractory nAMD. Method: This retrospective case series analyzed patients with refractory nAMD who received aflibercept 8 mg at Taipei Veterans General Hospital between October 2024 and April 2025. The main outcomes assessed were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the initial treatment period. Secondary outcomes included evaluation of subretinal fluid (SRF), intraretinal fluid (IRF), and alterations in pigment epithelial detachment (PED) height. Data were analyzed using nonparametric statistical methods. Result: This study included 12 eyes with refractory nAMD, 5 with refractory polypoidal choroidal vasculopathy (PCV), and 3 with refractory pachychoroid neovasculopathy (PNV), all treated with aflibercept 8 mg. Over a 3-month follow-up, no significant improvement in BCVA was observed, while CMT showed significant reductions at all time points. PED height also significantly decreased at the 1- and 3-month visits per Wilcoxon signed-rank test. Although SRF prevalence declined, the change was not statistically significant. A dry macula was achieved in 45% of eyes. Around half or more of the eyes showed a CMT reduction &gt;50 μm, with proportions of 50.0%, 54.5%, and 57.1% at months 1, 2, and 3, respectively. Conclusion: Aflibercept 8 mg demonstrated favorable anatomical outcomes in patients with refractory nAMD. Further studies are warranted to identify factors associated with treatment response and optimize patient selection. Trial registration The retrospective study design obtained approval from the Institutional Review Board of Taipei Veterans General Hospital, and all study procedures adhered to the principles outlined in the Declaration of Helsinki. The need for informed consent was waived by the Institutional Review Board of Taipei

Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients, driven primarily by inflammation, oxidative stress, and increased vascular permeability. Current standard therapies, while effective, have limitations. Curcuminoids, derived from Curcuma longa, possess potent anti-inflammatory, antioxidant, and anti-angiogenic properties, suggesting potential therapeutic value in DME. However, clinical evidence requires synthesis. This meta-analysis aimed to evaluate the efficacy of curcuminoid supplementation on Central Macular Thickness (CMT) and Best-Corrected Visual Acuity (BCVA) in patients with DME. A literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 1st, 2013, to December 31st, 2023. We included randomized controlled trials (RCTs) and controlled clinical trials comparing curcuminoid supplementation (as adjunct or monotherapy) against placebo or standard care alone in patients with DME, reporting CMT and/or BCVA outcomes. Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool 2 (RoB 2). Data were pooled using a random-effects model, calculating the Mean Difference (MD) with 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I² statistic. Six studies (comprising 388 patients) met the inclusion criteria. The included studies varied in curcuminoid formulations, dosages (ranging from 80 mg to 1500 mg daily), and follow-up durations (3 to 12 months). The overall risk of bias across studies was mixed, with some concerns primarily related to blinding and outcome reporting in several trials. Meta-analysis demonstrated that curcuminoid supplementation was associated with a statistically significant reduction in CMT compared to control groups (MD = -28.54 μm; 95% CI [-45.11, -11.97]; p = 0.0007). Moderate heterogeneity was observed (I² = 62%, p = 0.02). For BCVA (LogMAR), curcuminoid supplementation showed a trend towards improvement, but the result was not statistically significant (MD = -0.04 LogMAR; 95% CI [-0.09, 0.01]; p = 0.11). Heterogeneity for BCVA was low (I² = 15%, p = 0.31). In conclusion, adjunctive curcuminoid supplementation may contribute to a modest but statistically significant reduction in CMT in patients with DME. No statistically significant improvement in BCVA was confirmed, although a favourable trend was observed. Significant heterogeneity in CMT results and methodological limitations in primary studies necessitate cautious interpretation. Larger, well-designed RCTs with standardized, bioavailable curcuminoid formulations and longer follow-up are warranted to definitively establish the clinical role of curcuminoids in DME management.

To compare the efficacy of intravitreal antivascular endothelial growth factor (anti-VEGF) agents with oral carbonic anhydrase inhibitors (CAIs) in treating cystoid macular edema (CME) secondary to retinitis pigmentosa (RP). This retrospective study analyzed 98 patients (98 eyes) with RP-CME: 47 (48.0%) received intravitreal anti-VEGF agents (Ranibizumab or Bevacizumab) and 51 (52.0%) were treated with oral CAIs (methazolamide 50mg/day or acetazolamide 500mg/day). Medical records were reviewed to assess best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at baseline and at 1, 3, 6, and 12months post-treatment using Generalized Estimation Equations (GEE). Adverse events and risk factors influencing visual prognosis were also evaluated. Both groups showed significant improvement in BCVA and reduction in CMT at 1 and 3months post-treatment compared to baseline (all p < 0.001). In the oral CAIs group, these improvements persisted until 6months. However, by 12months, neither group exhibited significant improvements in BCVA or CMT compared to baseline (all p > 0.05). Intragroup comparisons revealed that the oral CAIs group had significantly better BCVA and CMT improvements at 3 and 6months than intravitreal anti-VEGF group (p < 0.001 for BCVA at 3months, p = 0.003 for BCVA at 6months; all p < 0.001 for CMT at both 3 and 6months). No significant differences were found between the two groups in BCVA and CMT at 12months or in IOP at any time point (all p > 0.05). Subgroup analysis indicated that oral acetazolamide was more effective than methazolamide in reducing CMT and improving BCVA at 3 and 6months (p = 0.005 for BCVA at 3months, p = 0.015 for BCVA at 6months; p = 0.037 for CMT at 3months, p < 0.001 for CMT at 6months). There were no significant differences in outcomes between intravitreal Ranibizumab and Bevacizumab (all p > 0.05). Correlation analysis showed that worse BCVA at 12months was associated with older age (r = 0.202, p = 0.046), higher baseline CMT (r = 0.353, p < 0.001), poorer baseline BCVA (r = 0.579, p < 0.001), but showed no correlation with genotype. Adverse effects from oral CAIs included tingling sensation (3.9%), altered taste (9.8%), and gastrointestinal upset (7.8%). The Ranibizumab group required an average of 3.7 ± 0.8 treatments, and the Bevacizumab group required an average of 3.8 ± 0.5 treatments over the course of 1year without experiencing severe adverse effects. Both intravitreal anti-VEGF agents and oral CAIs effectively improved CMT and BCVA in RP-CME patients within the first 3months of treatment. However, oral CAIs demonstrated superior anatomic and functional improvements at 6months. Poorer BCVA prognosis was associated with older age, higher baseline CMT, poorer baseline visual acuity. Larger, randomized clinical trials with extended follow-up periods are needed to confirm these findings.

Purpose To identify spectral-domain optical coherence tomography (SD-OCT) predictive morphological features for the outcome of Ranibizumab therapy for neovascular age-related macular degeneration (AMD). Methods This is a retrospective multicentric study that involved 64 eyes with naïve AMD. Patients who received three monthly intravitreal injections of Ranibizumab were stratified into (1) “responders” [≥ 5 letters gain on Early Treatment Diabetic Retinopathy Study (ETDRS) scale] and (2) “nonresponders” (< 5 letters gain). Best-corrected visual acuity (BCVA) and SD-OCT morphological features were compared at baseline and one month after three consecutive injections of Ranibizumab. Univariate and multivariate analyses were carried out to correlate these morphological features with the change in BCVA. Results Among the 64 patients enrolled, 40 (62.5%) were “responders” and 24 (37.5%) “nonresponders”. Age, sex, and BCVA were comparable between both groups. A multivariate correlational analysis found that subfoveal choroidal thickness (SFCT) and the presence of pigment epithelial detachment (PED) > 250 μm at baseline were two independent prognostic indicators of final BCVA. No other SD-OCT morphological studied features seem to affect final BCVA after Ranibizumab treatment. Conclusion SFCT and the presence of PED > 250 μm are two significant biomarkers that may predict improvement after Ranibizumab therapy for AMD. These markers may guide ophthalmologists' treatment decision under financial constraints and limited time.

The purpose of the study is to explore the morphofunctional fluctuations in eyes treated for neovascular AMD (nAMD) when treatment is switched from aflibercept or ranibizumab to brolucizumab. A total of 31 eyes of 31 patients with nAMD with type 1 macular neovascularization (MNV) were included. All patients were imaged using spectral domain optical coherence tomography (SD-OCT). The OCT acquisition was performed at the following visits: (i) “T1 visit” corresponding to the last follow-up examination in which an intravitreal injection of aflibercept or ranibizumab was performed before switching to brolucizumab because of the lack of improvement and (ii) “T2 visit” corresponding to the examination performed 1 month after T1, the latter visit corresponding to the day when a switch to brolucizumab injection was performed, (iii) and 1 month after the latter injection “(T3)”. The main outcome measures were: (1) central macular thickness (CMT), (2) choroidal vascularity index (CVI), (3) subfoveal choroidal thickness (CT), and best-corrected visual acuity (BCVA). Functional outcome showed significant differences at each time. Mean ± SD BCVA was 0.43 ± 0.12 LogMAR at T1 and 0.56 ± 0.16 LogMAR at T2 (p = 0.038). A significant improvement in BCVA was displayed at T3 (0.34 ± 0.21 LogMAR) as compared with T2 (p = 0.019). CMT analysis showed fluctuations three times. In detail, T2 displayed a thicker CMT in comparison with T1, although not statistically significant (p = 0.12). Contrariwise, T3 showed a thinner CMT in comparison with T2 (p = 0.002). Analyzing CVI among the three different times, the luminal choroidal area (LCA) and total choroidal area (TCA) showed significantly different values before and after switching to brolucizumab. T2 showed a significant reduction in both vessel lumen and total area compared with T1 (p = 0.032 and p = 0.046, respectively). Moreover, T3 showed a greater value of both LCA and TCA in comparison with T2 (p = 0.008 and p = 0.01, respectively). CT did not show significant differences at each time (p > 0.05). Our results reported early experiences on morphofunctional fluctuations in patients with nAMD who switched to brolucizumab. The anatomical impact of brolucizumab administration appears to result in choroidal vascular enlargement, accompanied by the resolution of subretinal fluid (SRF) and intraretinal fluid (IRF).

ObjectiveTo compare the visual outcomes of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in a...

PurposeTo evaluate 1‐year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO).MethodsA medical records was reviewed retrospectively for 22 patients (22 eyes) with macular edema secondary to central retinal vein occlusion. All of them were treated with intravitreal dexamethasone implant twice a year and followed up at least 1‐year from the first dexamethasone implant injection. The best‐corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) was measured at every 2 months after the first injection. Adverse effects including cataract formation, elevation of IOP were analyzed.ResultsMean age was 64.3 ± 9.5. Mean injection number was 2.4 ± 0.6 and interval between first and second injection was 22.0 ± 6.4 weeks. Additional treatments were performed with 11 patients (50%), bevacizumab in 9 and triamcinolone acetonide in 2. Mean BCVA (logMAR) was 0.79 ± 0.49 at pre‐injection and 0.72 ± 0.62 at 1 year. BCVA change was not significant (p = 0.638). But there was significant BCVA increase at 2, 4, 6 month after first injection (p &lt; 0.001). The number of patients who improved in BCVA was 10 (45.5%) at 1 year. Mean CMT at baseline was 627.3 ± 149.7 μm and 458.4 ± 139.0 μm at 1 year, significant decrease compared to baseline (p &lt; 0.001). In subgroup analysis, Hypertension (HTN) group showed significant improvement in BCVA and CMT compared to non‐HTN group (p = 0.044; BCVA, p = 0.005; CMT). Ischemic group represented significant decrease at CMT (p &lt; 0.001). Elevated intraocular pressure was observed in 6 eyes (27.3%). Cataract formation was in 3 eyes (13.6%).ConclusionsIntravitreal dexamethasone implant was effective in stabilizing visual acuity and reduction of macular edema in patients with macular edema secondary to central retinal vein occlusion.

PurposeTo evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasone implant for tractional and nontractional refractory diabetic macular edema (DME).MethodsThirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjects who were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implant injection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressure and other complications were investigated postoperatively.ResultsIn eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12 months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baseline after vitrectomy (p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvement in BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendency to decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressure elevation, which was addressed using antiglaucoma medication, and there were no other severe complications.ConclusionsVitrectomy combined with intraoperative dexamethasone implant may be safe and effective in treating DME, especially tractional DME. In this study, patients with nontractional DME required more additional treatments and time for anatomical and functional improvement compared to patients with tractional DME.

Comparison of Loading Doses of Ziv-Aflibercept and Aflibercept in Neovascular Age-Related Macular Degeneration.

Purpose To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies. Methods Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well. Results Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = −0.28, 95% CI = −0.37, −0.20; p < 0.001), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = −0.31, 95% CI = −0.40, −0.22; in the RD group, MD = −0.22, 95% CI = −0.41, −0.03), with no difference between the two groups (p=0.41). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = −129.75, 95% CI = −157.49, −102.01; p < 0.001). In the ERM group, a significant CMT reduction was shown following DEX (MD = −133.41, 95% CI = −155.37, −111.45; p < 0.001), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = −128.37, 95% CI = −253.57, −3.18; p=0.040), with significant heterogeneity. No difference in CMT improvement was found between the two groups (p=0.94). Conclusion This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy.