Michael Massengill, MD
Bascom Palmer Eye Institute, Miami, FL
Dr. Giovanni Staurenghi delivered an insightful presentation on the Differential Diagnosis of Macular Atrophy. He emphasized the importance of distinguishing age-related macular degeneration (AMD) from other macular atrophies, noting that current treatments may slow disease progression in AMD, whereas other conditions may require different management strategies.
Dr. Staurenghi highlighted the critical role of multimodal imaging in differentiating these conditions, as early degenerative changes on OCT often overlap across multiple diseases. He emphasized that the integration of FAF, OCT angiography, and ICG angiography is essential for precise phenotyping.
Using illustrative examples, he demonstrated how mitochondrial disease and Malattia Leventinese share nasal changes on FAF but exhibit distinct deposit characteristics on OCT. He also discussed the utility of ICG angiography in differentiating Stargardt disease, characterized by a “dark atrophy” pattern, from AMD. Similarly, ICG angiography can reveal “dark atrophy” in central areolar choroidal dystrophy and subtle angioid streaks in pseudo-xanthoma elasticum.
Dr. Staurenghi pointed out that reticular pseudodrusen are visible on OCT in several disease states, and the extent of dark signal on FAF can provide clues to the underlying etiology. He concluded his excellent presentation by stressing the importance of a thorough medication review to address the possibility of toxic maculopathies.
Faricimab for PCV: SALWEEN trial
Dr. Gemmy Cheung Chui Min presented on the use of faricimab for polypoidal choroidal vasculopathy (PCV), with a particular focus on the week 16 results from the Phase 3b/4 SALWEEN trial. She began by highlighting faricimab’s excellent safety and efficacy profile in age-related macular degeneration (AMD), while noting that PCV cases have been limited in pivotal studies of the drug, including the landmark TENAYA and LUCERNE trials.
The SALWEEN trial enrolled 135 patients aged >50 years across 38 study sites in nine countries in Asia. Participants had symptomatic PCV confirmed by ICG angiography, with evidence of macular exudation or hemorrhage and a baseline VA between 20/32 and 20/320. Key exclusion criteria included extensive fibrosis, foveal atrophy, and massive subfoveal hemorrhage.
The study design was adapted from the TENAYA/LUCERNE trials. Patients received four initial doses of faricimab 6.0 mg every four weeks, followed by disease activity assessments at weeks 20 and 24. Based on disease activity, treatment intervals were assigned (Q8W, Q12W, or Q16W) through primary endpoints at weeks 40, 44, and 48, with a subsequent treat-and-extend phase (Q8W–Q20W) extending up to 108 weeks.
At the week 16 interim analysis, the results were promising: patients demonstrated an average gain of 7.8 letters and a reduction in central subfield thickness (CST) of ~145 microns. Fluid reduction was notable, with absence of subretinal fluid (SRF), intraretinal fluid (IRF), or both in approximately 83%, 95%, and 80% of participants, respectively. Furthermore, ICG angiography showed complete regression of polypoidal lesions in 51% of subjects, while combined ICG and OCT imaging demonstrated polypoidal inactivity in 86%.
Dr. Cheung compared these findings to prior studies such as EVEREST II, PLANET, and the PULSAR PCV cohort, highlighting the similarities in outcomes. She also emphasized the favorable safety profile of faricimab in the trial, mentioning one case of retinal vasculitis that was later ruled out upon independent review of imaging.
Dr. Cheung concluded her excellent presentation with an illustrative case of a patient with PCV who received faricimab per the treatment protocol in the SALWEEN study, demonstrating a robust therapeutic response.