Wide-Field Choroidal Thickness Changes after Loading-Phase Anti-VEGF Therapy in Treatment- Naïve Neovascular AMD

Purpose: While it is known that anti-vascular endothelial growth factor (anti-VEGF) treatment for neovascular age-related macular degeneration (nAMD) leads to a reduction in choroidal thickness in the macula, changes in peripheral choroidal thickness remain unclear. This study aimed to evaluate choroidal thickness changes following three monthly intravitreal injections of aflibercept and faricimab in treatment-naïve nAMD. Methods: Patients with treatment-naïve nAMD who received either faricimab or aflibercept for three consecutive monthly injections as the loading phase were enrolled in this study. Wide-field swept-source OCT was used to quantify regional choroidal thickness. In the 1:1 propensity score matching, sex, age, baseline best-corrected visual acuity, axial length, and nAMD subtypes were selected as covariates. Results: A total of 145 eyes from 142 patients were included, with 72 eyes receiving aflibercept and 73 eyes receiving faricimab. Significant reductions in choroidal thickness were observed in both central and peripheral areas, with the most pronounced changes occurring in the central 3mm-subfield. After propensity score matching, choroidal thickness change rates were compared between the two drug groups. In the central 3mm-subfield, aflibercept was associated with a significantly greater reduction in choroidal thickness compared with faricimab. No significant differences were observed in other subfields. Conclusion: This study highlights the importance of considering both central and peripheral choroidal changes when evaluating the impact of different anti-VEGF therapies in nAMD.