Neovascular Age-Related Macular Degeneration Complicated by Large Submacular Hemorrhage Managed with Faricimab Monotherapy

Abstract Purpose: To evaluate the visual and anatomic outcomes of intravitreal faricimab monotherapy in neovascular age-related macular degeneration (nAMD) patients presenting with large submacular hemorrhage (SMH). Methods: Patients with neovascular age-related macular degeneration (nAMD) presenting with at least 50% subretinal hemorrhage (SRH) involving the fovea were identified. Patients with greater than 750 microns of total thickness of subfoveal hemorrhage were excluded. Patients were treated with faricimab as first line therapy utilizing a treat-extend-stop protocol for one year. Spectral domain optical coherence tomography (SD-OCT) and fluorescein angiogram (FA)/ indocyanine green angiography (ICG) were used to determine total CNV lesion size, SRH area size, and macular thickness. Visual acuity and SD-OCT were also obtained at each visit. Results: Six patients were identified that met the inclusion criteria. There were two males and four females. The average age of was 83.0 years. Prior to treatment, the average total CNV lesion size was 19.7mm2 and the average hemorrhage area was 14.5 mm2 for an average SRH percentage of 73.8%. The average central macular thickness (CMT) prior to treatment was 478.3 um and the average CMT 6 months after beginning treatment was 306.8 um (p=0.0031). The average CMT 1 year after treatment was 259.0um (p=0.0017). Average ETDRS letters before treatment was 48.8 letters {Snellen equivalent 20/138} with a range of 23-70 letters. Average ETDRS letters after 6 months of treatment was 60.3 letters {Snellen equivalent 20/63} with a range of 42 to 76 letters (p=0.017). Average ETDRS letters after 1 year of treatment was 64.7 letters {Snellen equivalent 20/50} with a range from 26 to 80 letters (p<0.014). The average number of injections was 9.3 at 1 year. Conclusion: In patients with nAMD complicated by at least 50% SRH, there was improved vision and decreased CMT. The vision improved by over 3 lines of vision. These patients may be successfully managed with faricimab monotherapy. While visual acuity overall improved, some patients had more improvement than others likely due to the location of the CNV.