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

Wide-Field Choroidal Thickness Changes after Loading-Phase Anti-VEGF Therapy in Treatment- Naïve Neovascular AMD | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Wide-Field Choroidal Thickness Changes after Loading-Phase Anti-VEGF Therapy in Treatment- Naïve Neovascular AMD Yosuke Fukuda, Shoji Notomi, Satomi Shiose, Yusuke Maehara, Kodai Yuge, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7890508/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Graefe's Archive for Clinical and Experimental Ophthalmology → Version 1 posted You are reading this latest preprint version Abstract 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. neovascular age-related macular degeneration anti-vascular endothelial growth factor angiopoietin-2 wide-field optical coherence tomography and propensity score matching Key Messages What is known ･Anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) reduces choroidal thickness, both centrally and peripherally, and the effect is especially pronounced in pachychoroid neovasculopathy. What is new ･Using wide-field swept-source optical coherence tomography, this study demonstrated that anti-VEGF therapy also reduces peripheral choroidal thickness in treatment-naïve nAMD, with a more pronounced effect in the central region. ･After adjustment with propensity score matching, aflibercept was found to induce greater central choroidal thinning than faricimab, highlighting distinct drug-specific choroidal responses. Introduction Neovascular age-related macular degeneration (nAMD) is characterized by macular neovascularization and is caused mainly by vascular endothelial growth factor (VEGF), which promotes angiogenesis and increases vascular permeability. Anti-VEGF therapy has significantly enhanced outcomes and is regarded as the standard treatment for nAMD [ 1 – 6 ]. Beyond suppressing the formation of neovascularization and leakage from them, anti-VEGF administration also reduces choroidal thickness, potentially through decreased vascular permeability, vasoconstrictive effects, and improvement of inflammation [ 2 , 7 – 10 ]. Koizumi et al. reported that subfoveal choroidal thickness (SFCT) was thinner after three monthly loading injections in treatment-naïve nAMD compared with baseline [ 10 ]. After the completion of the three monthly injections, maintenance injections were administered every two months; notably, two months after the last injection SFCT was thicker than that at one month. Additionally, another study observed a thicker SFCT at one month than two weeks post-injection [ 11 ]. Considering these findings, it is suggested that the amount of anti-VEGF drug remaining in the eye may be related to choroidal thickness to some extent. While previous reports on choroidal thickness have been limited to subfovea or macula, recent attention has focused on analyzing thickness including the peripheral areas in nAMD or pachychoroid diseases with the development of optical coherence tomography (OCT) technology [ 12 – 14 ]. Wide-field OCT (WF-OCT) has been applied to evaluate choroidal thickness changes after treatment in conditions such as central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) [ 15 – 17 ]. More recently, the choroidal response to anti-VEGF therapy in nAMD has also been demonstrated using WF-OCT [ 18 ]. Building on these findings, the present study aimed to compare the effects of different anti-VEGF agents on choroidal thickness in nAMD. In previous review articles, it has been reported that aflibercept reduces choroidal thickness more significantly than ranibizumab [ 19 ]. While the number of anti-VEGF drugs available for the treatment of nAMD has been increasing, the differences in their effects on choroidal structure, particularly between aflibercept and faricimab, remain unreported. Recently, the structural differences in the choroid, including the peripheral areas, have become a topic of active discussion in the context of nAMD and pachychoroid diseases. Direct comparisons of the impact of different anti-VEGF drugs on the choroid are valuable for optimizing drug selection and treatment strategies. To accurately compare the effects between drugs, it is crucial to control for patient background as much as possible because differences in age or subtypes of nAMD may lead to variations in treatment outcomes [ 20 , 21 ]. To mitigate selection bias, propensity score matching (PSM), a method that accounts for covariates influencing the likelihood of receiving a particular treatment, is commonly employed [ 22 ]. In this study, we investigated changes in choroidal thickness before and after treatment with three consecutive monthly injections of anti-VEGF drugs as initial treatment for treatment-naïve AMD using WF-OCT. Additionally, we investigated whether there are differences in choroidal thickness changes before and after treatment between aflibercept and faricimab using PSM. Methods Patients This retrospective study protocol received ethics approval from the Institutional Review Board of Kyushu University (Fukuoka, Japan). All procedures adhered to the Declaration of Helsinki, and analyses were performed on de-identified data. We enrolled consecutive eyes with treatment-naïve nAMD that completed a three monthly intravitreal injections of anti-VEGF at Kyushu University Hospital from March 2021 to June 2024, using 2.0 mg/0.05 mL aflibercept (EYLEA®; Regeneron Pharmaceutical, Inc., and Bayer, Tarrytown, NY, USA) or 6.0 mg/0.05 mL faricimab (Vabysmo®; F Hoffmann-La Roche, Grenzacherstrasse, Basel, Switzerland). Eyes failing to complete the loading series were excluded. During the study period, ranibizumab was typically used for retinal angiomatous proliferation (RAP), and half-fluence photodynamic therapy (PDT) was combined for PNV; accordingly, most RAP and PNV cases were excluded from this study. With respect to treatment eras, aflibercept was predominated from March 2021 to August 2022, whereas faricimab was introduced in September 2022 and remained principal loading agent through June 2024. At the initial visit, both eyes underwent a comprehensive assessment that included best-corrected visual acuity (BCVA) with a Landolt C chart, slit-lamp biomicroscopy, intraocular pressure, 45-degree color fundus photography, fluorescein/indocyanine-green angiography (FA/ICGA), near-infrared reflectance spectroscopy, fundus autofluorescence imaging (HRA-II; Heidelberg Engineering Inc., Dossenheim, Germany), and spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA + OCT or Cirrus™ 5000 HD-OCT, Zeiss, Dublin, CA), and wide-field swept-source OCT (WF SS-OCT; Xephilio OCT-S1, Canon Medical Systems, Tokyo, Japan). During the loading phase, the same examination was repeated at each follow-up, with the exception that FA/ICGA, SD-OCT with Spectralis HRA, and WF SS-OCT. these were repeated after completion of the loading series (one month after the third injection). Eyes with poor-quality or noisy WF SS-OCT en face images were excluded from this study. WF SS-OCT acquisition and regionalization for Evaluations of choroidal thickness Using WF SS-OCT, we obtained volumetric scans covering 20 mm (vertical) x 23 mm (horizontal), with scan depth of 5.3 mm. Choroidal thickness was defined as the vertical distance from the Bruch’s membrane to the chorioscleral interface. Segmentation was automatically performed using built-in software (Xephilio OCT-S1) and verified with manual edits when needed. To reduce peripheral geometric distortion before quantification, we applied the manufacturer’s automatic real-shape correction algorithm (Canon Inc.; US patent 9149181 B2). For regional analyses, we overlaid a fovea-centered concentric grid with 3-, 9-, and 18-mm diameters. The 3–9 mm and 9–18 mm subfield were each partitioned into four quadrants (supratemporal, infratemporal, supranasal, and infranasal), as previously reported [ 15 ]. Statistical analyses To reduce allocation bias in the comparison between the two anti-VEGF agents, the propensity score for receiving faricimab and aflibercept was estimated via logistic regression with sex, age, baseline BCVA, axial length, and nAMD subtype as covariates. Eyes were then matched 1:1 by nearest neighbor pairing without replacement, using a caliper of 0.2 standard deviation (SD) on the logit of the score, such that each faricimab-treated eye was paired to an aflibercept-treated eye of similar propensity. Categorical variables were reported as counts (percentages), and continuous variables as means ± SD. We used the Wilcoxon signed-rank test for within-eye pre–post and regional comparisons. In matched pairs after PSM, we assessed differences using the Wilcoxon signed-rank test on within-pair differences. Baseline categorical and continuous variables were compared with Fisher’s exact and Mann–Whitney U tests, respectively. A P-value of 0.05 was used as the cut-off value for significance. Results Characteristics of the enrolled patients. One hundred and forty-five eyes of 142 patients were enrolled. The mean ± standard deviation (SD) age was 74.6 ± 8.7 years, and there were 111 males and 31 females. The mean ± SD axial length was 24.6 ± 1.1 mm. The mean ± SD baseline BCVA was 0.30 ± 0.36 logMAR and the mean ± SD central macular thickness (CMT) was 332.8 ± 96.3 μm. We included 78 eyes with typical AMD (tAMD, 70 patients), 56 with polypoidal choroidal vasculopathy (PCV, 55 patients), 8 with PNV, 3 with retinal angiomatous proliferation (RAP). We administered aflibercept to 72 eyes and faricimab to 73 eyes ( Table 1 ). 145 eyes of 142 patients, n (%) or mean ± SD Male 111 (78.2 %) Age (y) 74.6 ± 8.7 Axial length (mm) 24.6 ± 1.1 BCVA (logMAR) 0.30 ± 0.36 CMT (μm) 332.8 ± 96.3 nAMD subtypes tAMD 78 (53.8%) PCV 56 (38.7%) PNV 8 (5.5%) RAP 3 (2.1%) A nti-VEGF drugs Aflibercept 72 (49.7%) Faricimab 73 (50.3%) Table 1. Patients’ characteristics before the treatment. SD: standard deviations, BCVA: best-corrected visual acuity, logMAR: logarithm of the minimum angle of resolution, CMT: central macular thickness, nAMD: neovascular age-related macular degeneration, tAMD: typical age-related macular degeneration, PCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy, RAP: retinal angiomatous proliferation VEGF: vascular endothelial growth factor Choroidal thickness before and after treatment. A significant decrease in choroidal thickness was observed after treatment in all areas (p < 0.001; Table 2 ). Additionally, we investigated whether the choroid was more likely to become thinner in the posterior (9 mm subfield) or peripheral (9–18 mm subfield) areas. Results showed that choroidal thickness significantly decreased in the 9 mm subfield compared to that in the 9–18 mm subfield (p < 0.001; Table 3 ). Areas Before treatment After treatment P-value 3mm-subfield 231.5 ± 72.8 211.3 ± 70.1 <0.001 3-9mm-subfield 189.3 ± 55.4 172.3 ± 52.1 <0.001 Supratemporal 3–9 mm 234.6 ± 65.1 212.3 ± 57.0 <0.001 Infratemporal 3–9 mm 210.3 ± 67.1 189.5 ± 61.3 <0.001 Supranasal 3–9 mm 208.2 ± 67.3 193.3 ± 67.7 <0.001 Infranasal 3–9 mm 177.8 ± 67.1 161.0 ± 62.7 <0.001 9-18mm-subfield 171.9 ± 44.4 160.0 ± 38.8 <0.001 Supratemporal 9–18 mm 209.6 ± 50.2 196.5 ± 46.3 <0.001 Infratemporal 9–18 mm 173.3 ± 50.8 159.0 ± 43.0 <0.001 Supranasal 9–18 mm 175.3 ± 54.2 164.6 ± 49.8 <0.001 Infranasal 9–18 mm 129.4 ± 40.5 119.9 ± 34.3 <0.001 Table 2. Choroidal thickness before and after three monthly injections. The data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test, comparing choroidal thickness before and after treatment. Areas Before treatment After treatment Ratio P-value 9mm-subfield 189.3 ± 55.4 172.3 ± 52.1 0.91 ± 0.08 <0.001 9-18mm-subfield 171.9 ± 44.4 160.0 ± 38.8 0.94 ± 0.06 Table 3. Ratio of change in choroidal thickness before and after treatment in the posterior area and in the peripheral area. The data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test. Difference in choroidal thickness changes between aflibercept and faricimab. The differences in choroidal thickness changes between the aflibercept group (72 eyes) and the faricimab group (73 eyes) were evaluated. The baseline characteristics before and after PSM are shown in Table 4 and Table 5 . Prior to PSM, significant differences were observed in age and nAMD subtype between the two groups. Additionally, the aflibercept group exhibited significantly greater baseline choroidal thickness across all subfields. After applying PSM, no significant differences were found in sex, age, CMT, the proportion of patients with nAMD subtypes, or choroidal thickness in any subfield between the two groups. Subsequent comparisons were conducted using the matched dataset. Table 6 presents the changes in choroidal thickness rates between the aflibercept and faricimab group. Both groups showed significant choroidal thinning across all subfields following treatment. However, in the central 3mm-subfield, the aflibercept group showed a significantly greater reduction in choroidal thickness than the faricimab group. In the 3-9mm-subfield, a marginal difference was observed, with a trend toward a greater reduction in the aflibercept group, although this did not reach statistical significance. No significant differences were found in the 9–18 mm subfield. Aflibercept Faricimab P-value n 72 73 Male, n (%) 60 (83.3%) 51 (69.9%) 0.08 Age (y ± SD) 72.6 ± 10.1 76.6 ± 6.6 0.05 Axial length (mm ± SD) 24.7 ± 1.1 24.6 ± 1.1 0.47 nAMD subtypes, n (%) 0.01 tAMD 32 (44.4%) 46 (63.0%) PCV 33 (45.8%) 23 (31.5%) PNV 7 (9.7%) 1 (1.4%) RAP 0 (0%) 3 (4.1%) Choroidal thickness (μm± SD) 3mm-subfield 245.9 ± 73.7 217.3 ± 69.6 0.018 3-9mm-subfield 203.6 ± 57.5 175.3 ± 49.8 0.002 Supratemporal 3–9 mm 250.7 ± 68.3 218.8 ± 58.0 0.003 Infratemporal 3–9 mm 226.8 ± 72.6 194.0 ± 57.0 0.003 Supranasal 3–9 mm 223.0 ± 66.2 193.7 ± 65.7 0.008 Infranasal 3–9 mm 194.5 ± 72.7 161.4 ± 56.9 0.003 9-18mm-subfield 183.5 ± 49.9 160.5 ± 35.0 0.002 Supratemporal 9–18 mm 221.0 ± 54.4 198.2 ± 43.3 0.006 Infratemporal 9–18 mm 187.8 ± 59.3 159.1 ± 35.6 0.001 Supranasal 9–18 mm 185.6 ± 56.8 165.2 ± 49.8 0.023 Infranasal 9–18 mm 139.4 ± 46.6 119.5 ± 30.6 0.003 Table 4. Patients’ characteristics before propensity score matching P-values were calculated using Fisher’s exact test for categorical data and the Mann–Whitney U test for continuous data. SD: standard deviations, nAMD: neovascular age-related macular degeneration, tAMD: typical age-related macular degeneration, PCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy, RAP: retinal angiomatous proliferation Aflibercept Faricimab P-value n 48 48 Male, n (%) 37 (77.1%) 35 (72.9%) 0.81 Age (y ± SD) 74.4 ± 9.2 75.0 ± 6.6 0.68 Axial length (mm ± SD) 24.6 ± 1.1 24.7 ± 1.1 0.69 nAMD subtypes, n (%) 0.91 tAMD 27 (56.3%) 29 (60.4%) PCV 20 (41.7%) 18 (37.5%) PNV 1 (2.1%) 1 (2.1%) RAP 0 (0%) 0 (0%) Choroidal thickness (μm± SD) 3mm-subfield 226.4 ± 69.2 228.5 ± 72.1 0.89 3-9mm-subfield 184.8 ± 52.5 186.3 ± 48.2 0.89 Supratemporal 3–9 mm 228.3 ± 61.6 232.7 ± 54.7 0.71 Infratemporal 3–9 mm 204.3 ± 65.8 203.1 ± 53.8 0.92 Supranasal 3–9 mm 203.5 ± 60.3 207.7 ± 64.1 0.74 Infranasal 3–9 mm 174.9 ± 67.9 173.9 ± 60.0 0.94 9-18mm-subfield 168.3 ± 41.9 167.9 ± 35.2 0.96 Supratemporal 9–18 mm 204.5 ± 44.7 208.1 ± 43.1 0.68 Infratemporal 9–18 mm 167.6 ± 43.7 166.3 ± 35.8 0.87 Supranasal 9–18 mm 172.4 ± 52.0 172.1 ± 49.8 0.98 Infranasal 9–18 mm 128.6 ± 43.2 125.2 ± 32.2 0.66 Table 5. Patients’ characteristics after propensity score matching P-values were calculated using Fisher’s exact test for categorical data and the Mann–Whitney U test for continuous data. SD: standard deviations, nAMD: neovascular age-related macular degeneration, tAMD: typical age-related macular degeneration, PCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy, RAP: retinal angiomatous proliferation Areas Aflibercept Faricimab P-value n = 48 n = 48 3mm-subfield 0.89 ± 0.09 0.95 ± 0.14 0.04 3-9mm-subfield 0.90 ± 0.07 0.92 ± 0.08 0.08 Supratemporal 3–9 mm 0.90 ± 0.08 0.92 ± 0.08 0.17 Infratemporal 3–9 mm 0.90 ± 0.11 0.92 ± 0.08 0.18 Supranasal 3–9 mm 0.90 ± 0.11 0.93 ± 0.09 0.16 Infranasal 3–9 mm 0.89 ± 0.08 0.92 ± 0.11 0.16 9-18mm-subfield 0.93 ± 0.06 0.94 ± 0.06 0.51 Supratemporal 9–18 mm 0.94 ± 0.09 0.95 ± 0.08 0.73 Infratemporal 9–18 mm 0.92 ± 0.06 0.93 ± 0.06 0.26 Supranasal 9–18 mm 0.94 ± 0.07 0.95 ± 0.07 0.49 Infranasal 9–18 mm 0.93 ± 0.06 0.94 ± 0.07 0.94 Table 6. Differences in choroidal thickness change rates between aflibercept and faricimab. The data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test. Discussion In this study, we used WF SS-OCT to evaluate changes in choroidal thickness before and after three consecutive monthly intravitreal injections of anti-VEGF agents in treatment-naïve nAMD patients. Significant reductions in choroidal thickness were observed in both central and peripheral areas, demonstrating that the choroidal thinning effect of anti-VEGF therapy extends beyond the macular area. Additionally, the degree of thinning was significantly greater in the central area compared to the peripheral area. Recently, Wakugawa et al. reported choroidal thickness changes after anti-VEGF therapy in nAMD using WF-OCT, demonstrating that overall choroidal thinning was more pronounced in PNV cases [ 18 ]. At our facility, typical PNV cases are treated with half-fluence PDT in combination with anti-VEGF therapy, and therefore only a small number of PNV cases were included in the present study. In addition to the previous findings, we examined differences in choroidal thinning between drugs using PSM and revealed that, in the central 3-mm subfield, the aflibercept group showed significantly greater choroidal thinning compared with the faricimab group. Thus, this study demonstrated, using PSM, that aflibercept induces greater central choroidal thinning than faricimab in nAMD other than PNV. In a previous study, we reported a significant reduction in choroidal thickness in the peripheral areas following a single injection of aflibercept combined with half-fluence PDT for PNV at the 3-month follow-up, which yielded similar results [ 15 ]. In that study, the choroidal thickness change rates in PNV were 0.88 in the central 9mm-subfield and 0.91 in the peripheral 9-18mm-subfield. In the current study, following three monthly injections of anti-VEGF agents in nAMD, the corresponding ratios were 0.91 in the central 9mm-subfield and 0.94 in the peripheral 9-18mm-subfield. While direct comparison is limited due to differences in patient backgrounds, both studies consistently show a more pronounced thinning in the central areas. Importantly, our data do not support a simple model wherein thicker baseline areas thin more after treatment. It has been reported that in healthy eyes, as well as in CSC and PNV, the supratemporal quadrant is the thickest, while the infranasal quadrant is the thinnest. A similar trend was observed in the present nAMD cohort before [ 12 ]. However, when examining the choroidal thickness change rates with treatment, no significant difference was found between the supratemporal and infranasal areas, indicating that both areas experienced similar reductions in choroidal thickness. This suggests that the initial choroidal thickness alone does not determine its susceptibility to treatment-induced thinning, but rather that the macular area is inherently more responsive to anti-VEGF effects. In a previous study analyzing choroidal thickness in treatment-naïve nAMD patients, we reported that PNV had a more pronounced central choroidal thickening [ 12 ]. These findings indicate that both nAMD onset and treatment can lead to significant changes in the central choroidal structure. In nAMD, choroidal thinning after anti-VEGF therapy has been well documented [ 10 ]. This effect is mainly attributed to a reduction in luminal volume rather than stromal tissue [ 23 , 24 ], along with decreased vascular density of the choriocapillaris [ 25 ], suggesting that anti-VEGF therapy reduces choroidal blood flow. In the present study, choroidal thickness in the central 3mm-subfield was significantly more reduced in the aflibercept group than in the faricimab group. Furthermore, faricimab has been reported to have limited effectiveness when switching from aflibercept, particularly in patients with greater baseline choroidal thickness [ 26 ]. In our previous analysis comparing outcomes after the loading phase, although no significant difference was found, there was a tendency for aflibercept to induce greater subfoveal choroidal thinning [ 20 ]. These differences between the two drugs may result from the distinct molecular targets each drug inhibits [ 27 ]. Notably, faricimab’s additional inhibition of angiopoietin-2 is thought to promote vascular stabilization, possibly mitigating excessive choroidal thinning. Patients with thicker choroids may have pachychoroid features and exhibit resistance to anti-VEGF therapy [ 28 ]. If aflibercept more effectively reduces choroidal thickness, it may be the preferred agent in such cases. Additionally, in combination therapy with PDT for PNV, where choroidal thickening is prominent, the aflibercept may be a logical choice. Conversely, thin choroids are considered a risk factor for macular atrophy during treatment [ 29 ]. Previous studies have shown that aflibercept has a greater effect on choroidal thinning than ranibizumab [ 19 ]. In our hospital, ranibizumab is commonly used to treat RAP. As a result, RAP cases were few in this study; indeed, none remained after PSM. Based on the current findings, which suggest that aflibercept has a greater choroidal thinning effect than faricimab, it may be preferable to use ranibizumab or faricimab for patients with thin choroids at baseline, such as those with RAP. For patients with treatment-resistant RAP already receiving ranibizumab, switching to faricimab may be more beneficial than switching to aflibercept. There are some limitations in this study. First, this single-center retrospective study enrolled a relatively small nAMD cohort. A large cohort may better clarify differential drug effects on choroidal thickness. Although WF SS-OCT enabled extended choroidal mapping, the vortex vein ampulla was not captured because it lay outside the imaging field of view. Future studies incorporating this area may provide deeper insight into the underlying pathophysiology of nAMD. In conclusion, analysis using WF SS-OCT revealed that anti-VEGF therapy for nAMD reduces choroidal thickness not only in the central region but also in the peripheral areas, with more pronounced thinning observed centrally. Furthermore, after adjustment for patient background using PSM, comparison between aflibercept and faricimab demonstrated that aflibercept induced a greater reduction in central choroidal thickness. These findings underscore the importance of comprehensive choroidal evaluation with WF-OCT to optimize individualized treatment strategies. Declarations Author contributions Yosuke Fukuda and Shoji Notomi designed the study and drafted the manuscript. Yusuke Maehara, Kodai Yuge, Kohei Kiyohara, Yuta Yasaka, and Kenichiro Mori collected data. Satomi Shiose, Keijiro Ishikawa, Yusuke Murakami and Koh-Hei Sonoda critically reviewed the final version of the manuscript. All authors have read and agreed to the published version of the manuscript. Data availability statement All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author. Acknowledgements We would like to thank Editage (www.editage.com) for English language editing. Compliance with Ethical Standards Funding This work was supported by the Japan Society for the Promotion of Science, the Grant-in-Aid for Scientific Research; KAKENHI, JP25K12836 (to SN) and JP24KJ1780 (to YF). Competing of interest The authors declare that they have no conflicts of interest. 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J Clin Med 12. 10.3390/jcm12165364 Ishikura M, Muraoka Y, Nishigori N, Takahashi A, Miyake M, Ueda-Arakawa N, Miyata M, Ooto S, Tsujikawa A (2022) Widefield Choroidal Thickness of Eyes with Central Serous Chorioretinopathy Examined by Swept-Source OCT. Ophthalmol Retina 6:949–956. 10.1016/j.oret.2022.04.011 Funatsu R, Sonoda S, Terasaki H, Shiihara H, Mihara N, Horie J, Sakamoto T (2023) Choroidal morphologic features in central serous chorioretinopathy using ultra-widefield optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 261:971–979. 10.1007/s00417-022-05905-1 Fukuda Y, Notomi S, Shiose S, Maehara Y, Kiyohara K, Hashimoto S, Kano K, Ishikawa K, Hisatomi T, Sonoda KH (2024) Wide-Field Choroidal Thickness Analysis after Half-Fluence Photodynamic Therapy Combined with Intravitreal Aflibercept Injection in Pachychoroid Neovasculopathy. J Clin Med 13. 10.3390/jcm13061608 Matsumoto H, Hoshino J, Nakamura K, Kishi S, Akiyama H (2023) Attenuation of irradiated choroid and its regional vortex veins in central serous chorioretinopathy after photodynamic therapy. Sci Rep 13:19903. 10.1038/s41598-023-47325-z Funatsu R, Sonoda S, Terasaki H, Shiihara H, Mihara N, Horie J, Sakamoto T (2023) Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy. PLoS ONE 18:e0282057. 10.1371/journal.pone.0282057 Wakugawa S, Imanaga N, Terao N, Kuroshima C, Miyara Y, Maehira M, Koizumi H (2025) Changes in widefield choroidal thickness after anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration. Retina DOI. 10.1097/iae.0000000000004651 Yamashiro K, Oishi A, Hata M, Takahashi A, Tsujikawa A (2021) Visual acuity outcomes of anti-VEGF treatment for neovascular age-related macular degeneration in clinical trials. Jpn J Ophthalmol 65:741–760. 10.1007/s10384-021-00869-x Fukuda Y, Notomi S, Shiose S, Maehara Y, Kiyohara K, Fujiwara K, Hashimoto S, Kano K, Ishikawa K, Hisatomi T, Sonoda KH (2024) Three-month outcomes of treatment with faricimab or aflibercept for neovascular age-related macular degeneration: a propensity score matching study in a Japanese population. Graefes Arch Clin Exp Ophthalmol 262:3971–3978. 10.1007/s00417-024-06582-y Tanaka A, Hata M, Tsuchikawa M, Ueda-Arakawa NU, Tamura H, Miyata M, Takahashi A, Kido A, Muraoka Y, Miyake M, Ooto S, Tsujikawa A (2024) Short-Term Outcomes of 3 Monthly intravitreal Faricimab On Different Subtypes of Neovascular Age-Related Macular Degeneration. Clin Ophthalmol 18:507–516. 10.2147/opth.S448507 Austin PC (2011) An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res 46:399–424. 10.1080/00273171.2011.568786 Azuma K, Tan X, Asano S, Shimizu K, Ogawa A, Inoue T, Murata H, Asaoka R, Obata R (2019) The association of choroidal structure and its response to anti-VEGF treatment with the short-time outcome in pachychoroid neovasculopathy. PLoS ONE 14:e0212055. 10.1371/journal.pone.0212055 Pellegrini M, Bernabei F, Mercanti A, Sebastiani S, Peiretti E, Iovino C, Casini G, Loiudice P, Scorcia V, Giannaccare G (2021) Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 259:911–918. 10.1007/s00417-020-04957-5 Hikichi T, Agarie M (2019) Reduced Vessel Density of the Choriocapillaris during Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 60:1088–1095. 10.1167/iovs.18-24522 Todoroki T, Takeuchi J, Ota H, Nakano Y, Sajiki AF, Nakamura K, Kaneko H, Nishiguchi KM (2024) Aqueous Humor Cytokine Analysis in Age-Related Macular Degeneration After Switching From Aflibercept to Faricimab. Invest Ophthalmol Vis Sci 65:15. 10.1167/iovs.65.11.15 Maehara Y, Notomi S, Shiose S, Fukuda Y, Kiyohara K, Kano K, Ishikawa K, Hisatomi T, Sonoda KH (2025) Switching to faricimab alleviates persistent subretinal fluid and pigment epithelial detachment in neovascular age-related macular degeneration. Jpn J Ophthalmol. 10.1007/s10384-025-01264-6 Kumar JB, Wai KM, Ehlers JP, Singh RP, Rachitskaya AV (2019) Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration. Br J Ophthalmol 103:918–921. 10.1136/bjophthalmol-2018-312625 Fan W, Abdelfattah NS, Uji A, Lei J, Ip M, Sadda SR, Wykoff CC (2018) Subfoveal choroidal thickness predicts macular atrophy in age-related macular degeneration: results from the TREX-AMD trial. Graefes Arch Clin Exp Ophthalmol 256:511–518. 10.1007/s00417-017-3888-2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Graefe's Archive for Clinical and Experimental Ophthalmology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7890508","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532882531,"identity":"3216ef73-dcc3-430c-a8b0-65c6f059aa32","order_by":0,"name":"Yosuke Fukuda","email":"","orcid":"","institution":"Kyushu University","correspondingAuthor":false,"prefix":"","firstName":"Yosuke","middleName":"","lastName":"Fukuda","suffix":""},{"id":532882532,"identity":"74525445-f62f-4231-a1e0-fc47b96813d5","order_by":1,"name":"Shoji 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University","correspondingAuthor":false,"prefix":"","firstName":"Satomi","middleName":"","lastName":"Shiose","suffix":""},{"id":532882534,"identity":"c2ce33eb-88ef-4bec-ad7b-20aaec42e772","order_by":3,"name":"Yusuke Maehara","email":"","orcid":"","institution":"Kyushu University","correspondingAuthor":false,"prefix":"","firstName":"Yusuke","middleName":"","lastName":"Maehara","suffix":""},{"id":532882535,"identity":"a9eaef30-891f-46f0-9ce7-51fd5afb3a16","order_by":4,"name":"Kodai Yuge","email":"","orcid":"","institution":"Kyushu University","correspondingAuthor":false,"prefix":"","firstName":"Kodai","middleName":"","lastName":"Yuge","suffix":""},{"id":532882536,"identity":"a851dddf-4556-4eb9-96e5-c4b73e465e95","order_by":5,"name":"Kohei Kiyohara","email":"","orcid":"","institution":"Kyushu 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03:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7890508/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7890508/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00417-026-07130-6","type":"published","date":"2026-02-16T15:57:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":103251032,"identity":"498612aa-b2b9-423e-8e9b-f2ce3e6fa7fd","added_by":"auto","created_at":"2026-02-23 16:01:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1572528,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7890508/v1/422fc129-888f-4408-b1a9-e13e1cb8859b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Wide-Field Choroidal Thickness Changes after Loading-Phase Anti-VEGF Therapy in Treatment- Naïve Neovascular AMD","fulltext":[{"header":"Key Messages","content":"\u003cp\u003e\u003cem\u003eWhat is known\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e･Anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) reduces choroidal thickness, both centrally and peripherally, and the effect is especially pronounced in pachychoroid neovasculopathy.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat is new\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e･Using wide-field swept-source optical coherence tomography, this study demonstrated that anti-VEGF therapy also reduces peripheral choroidal thickness in treatment-na\u0026iuml;ve nAMD, with a more pronounced effect in the central region.\u003c/p\u003e\n\u003cp\u003e･After adjustment with propensity score matching, aflibercept was found to induce greater central choroidal thinning than faricimab, highlighting distinct drug-specific choroidal responses.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eNeovascular age-related macular degeneration (nAMD) is characterized by macular neovascularization and is caused mainly by vascular endothelial growth factor (VEGF), which promotes angiogenesis and increases vascular permeability. Anti-VEGF therapy has significantly enhanced outcomes and is regarded as the standard treatment for nAMD [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Beyond suppressing the formation of neovascularization and leakage from them, anti-VEGF administration also reduces choroidal thickness, potentially through decreased vascular permeability, vasoconstrictive effects, and improvement of inflammation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eKoizumi et al. reported that subfoveal choroidal thickness (SFCT) was thinner after three monthly loading injections in treatment-na\u0026iuml;ve nAMD compared with baseline [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. After the completion of the three monthly injections, maintenance injections were administered every two months; notably, two months after the last injection SFCT was thicker than that at one month. Additionally, another study observed a thicker SFCT at one month than two weeks post-injection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Considering these findings, it is suggested that the amount of anti-VEGF drug remaining in the eye may be related to choroidal thickness to some extent.\u003c/p\u003e\u003cp\u003eWhile previous reports on choroidal thickness have been limited to subfovea or macula, recent attention has focused on analyzing thickness including the peripheral areas in nAMD or pachychoroid diseases with the development of optical coherence tomography (OCT) technology [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Wide-field OCT (WF-OCT) has been applied to evaluate choroidal thickness changes after treatment in conditions such as central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. More recently, the choroidal response to anti-VEGF therapy in nAMD has also been demonstrated using WF-OCT [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Building on these findings, the present study aimed to compare the effects of different anti-VEGF agents on choroidal thickness in nAMD.\u003c/p\u003e\u003cp\u003eIn previous review articles, it has been reported that aflibercept reduces choroidal thickness more significantly than ranibizumab [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. While the number of anti-VEGF drugs available for the treatment of nAMD has been increasing, the differences in their effects on choroidal structure, particularly between aflibercept and faricimab, remain unreported. Recently, the structural differences in the choroid, including the peripheral areas, have become a topic of active discussion in the context of nAMD and pachychoroid diseases. Direct comparisons of the impact of different anti-VEGF drugs on the choroid are valuable for optimizing drug selection and treatment strategies.\u003c/p\u003e\u003cp\u003eTo accurately compare the effects between drugs, it is crucial to control for patient background as much as possible because differences in age or subtypes of nAMD may lead to variations in treatment outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. To mitigate selection bias, propensity score matching (PSM), a method that accounts for covariates influencing the likelihood of receiving a particular treatment, is commonly employed [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we investigated changes in choroidal thickness before and after treatment with three consecutive monthly injections of anti-VEGF drugs as initial treatment for treatment-na\u0026iuml;ve AMD using WF-OCT. Additionally, we investigated whether there are differences in choroidal thickness changes before and after treatment between aflibercept and faricimab using PSM.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003e This retrospective study protocol received ethics approval from the Institutional Review Board of Kyushu University (Fukuoka, Japan). All procedures adhered to the Declaration of Helsinki, and analyses were performed on de-identified data.\u003c/p\u003e\u003cp\u003eWe enrolled consecutive eyes with treatment-na\u0026iuml;ve nAMD that completed a three monthly intravitreal injections of anti-VEGF at Kyushu University Hospital from March 2021 to June 2024, using 2.0 mg/0.05 mL aflibercept (EYLEA\u0026reg;; Regeneron Pharmaceutical, Inc., and Bayer, Tarrytown, NY, USA) or 6.0 mg/0.05 mL faricimab (Vabysmo\u0026reg;; F Hoffmann-La Roche, Grenzacherstrasse, Basel, Switzerland). Eyes failing to complete the loading series were excluded. During the study period, ranibizumab was typically used for retinal angiomatous proliferation (RAP), and half-fluence photodynamic therapy (PDT) was combined for PNV; accordingly, most RAP and PNV cases were excluded from this study. With respect to treatment eras, aflibercept was predominated from March 2021 to August 2022, whereas faricimab was introduced in September 2022 and remained principal loading agent through June 2024.\u003c/p\u003e\u003cp\u003eAt the initial visit, both eyes underwent a comprehensive assessment that included best-corrected visual acuity (BCVA) with a Landolt C chart, slit-lamp biomicroscopy, intraocular pressure, 45-degree color fundus photography, fluorescein/indocyanine-green angiography (FA/ICGA), near-infrared reflectance spectroscopy, fundus autofluorescence imaging (HRA-II; Heidelberg Engineering Inc., Dossenheim, Germany), and spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA\u0026thinsp;+\u0026thinsp;OCT or Cirrus\u0026trade; 5000 HD-OCT, Zeiss, Dublin, CA), and wide-field swept-source OCT (WF SS-OCT; Xephilio OCT-S1, Canon Medical Systems, Tokyo, Japan). During the loading phase, the same examination was repeated at each follow-up, with the exception that FA/ICGA, SD-OCT with Spectralis HRA, and WF SS-OCT. these were repeated after completion of the loading series (one month after the third injection). Eyes with poor-quality or noisy WF SS-OCT en face images were excluded from this study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eWF SS-OCT acquisition and regionalization for Evaluations of choroidal thickness\u003c/h3\u003e\n\u003cp\u003eUsing WF SS-OCT, we obtained volumetric scans covering 20 mm (vertical) x 23 mm (horizontal), with scan depth of 5.3 mm. Choroidal thickness was defined as the vertical distance from the Bruch\u0026rsquo;s membrane to the chorioscleral interface. Segmentation was automatically performed using built-in software (Xephilio OCT-S1) and verified with manual edits when needed. To reduce peripheral geometric distortion before quantification, we applied the manufacturer\u0026rsquo;s automatic real-shape correction algorithm (Canon Inc.; US patent 9149181 B2).\u003c/p\u003e\u003cp\u003e For regional analyses, we overlaid a fovea-centered concentric grid with 3-, 9-, and 18-mm diameters. The 3\u0026ndash;9 mm and 9\u0026ndash;18 mm subfield were each partitioned into four quadrants (supratemporal, infratemporal, supranasal, and infranasal), as previously reported [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eTo reduce allocation bias in the comparison between the two anti-VEGF agents, the propensity score for receiving faricimab and aflibercept was estimated via logistic regression with sex, age, baseline BCVA, axial length, and nAMD subtype as covariates. Eyes were then matched 1:1 by nearest neighbor pairing without replacement, using a caliper of 0.2 standard deviation (SD) on the logit of the score, such that each faricimab-treated eye was paired to an aflibercept-treated eye of similar propensity. Categorical variables were reported as counts (percentages), and continuous variables as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. We used the Wilcoxon signed-rank test for within-eye pre\u0026ndash;post and regional comparisons. In matched pairs after PSM, we assessed differences using the Wilcoxon signed-rank test on within-pair differences. Baseline categorical and continuous variables were compared with Fisher\u0026rsquo;s exact and Mann\u0026ndash;Whitney U tests, respectively. A P-value of 0.05 was used as the cut-off value for significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of the enrolled patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne hundred and forty-five eyes of 142 patients were enrolled. The mean \u0026plusmn; standard deviation (SD) age was 74.6 \u0026plusmn; 8.7 years, and there were 111 males and 31 females. The mean \u0026plusmn; SD axial length was 24.6 \u0026plusmn; 1.1 mm. The mean \u0026plusmn; SD baseline BCVA was 0.30 \u0026plusmn; 0.36 logMAR and the mean \u0026plusmn; SD central macular thickness (CMT) was 332.8 \u0026plusmn; 96.3 \u0026mu;m. We included 78 eyes with typical AMD (tAMD, 70 patients), 56 with polypoidal choroidal vasculopathy (PCV, 55 patients), 8 with PNV, 3 with retinal angiomatous proliferation (RAP). We administered aflibercept to 72 eyes and faricimab to 73 eyes (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e145 eyes of 142 patients, n (%) or mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e111 (78.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e74.6 \u0026plusmn; 8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAxial length (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBCVA (logMAR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e0.30 \u0026plusmn; 0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCMT (\u0026mu;m)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e332.8 \u0026plusmn; 96.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003enAMD subtypes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003etAMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e78 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e56 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePNV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e8 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e3 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003enti-VEGF\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edrugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eAflibercept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e72 (49.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eFaricimab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e73 (50.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Patients\u0026rsquo; characteristics before the treatment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSD: standard deviations, BCVA: best-corrected visual acuity,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003elogMAR: logarithm of the minimum angle of resolution, CMT: central macular thickness,\u003c/p\u003e\n\u003cp\u003enAMD: neovascular age-related macular degeneration, tAMD: typical age-related macular degeneration,\u003c/p\u003e\n\u003cp\u003ePCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy,\u003c/p\u003e\n\u003cp\u003eRAP: retinal angiomatous proliferation\u003c/p\u003e\n\u003cp\u003eVEGF: vascular endothelial growth factor\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChoroidal thickness before and after treatment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant decrease in choroidal thickness was observed after treatment in all areas (p \u0026lt; 0.001; \u003cstrong\u003eTable 2\u003c/strong\u003e). Additionally, we investigated whether the choroid was more likely to become thinner in the posterior (9 mm subfield) or peripheral (9\u0026ndash;18 mm subfield) areas. Results showed that choroidal thickness significantly decreased in the 9 mm subfield compared to that in the 9\u0026ndash;18 mm subfield (p \u0026lt; 0.001; \u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e231.5 \u0026plusmn; 72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e211.3 \u0026plusmn; 70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e189.3 \u0026plusmn; 55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e172.3 \u0026plusmn; 52.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e234.6 \u0026plusmn; 65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e212.3 \u0026plusmn; 57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e210.3 \u0026plusmn; 67.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e189.5 \u0026plusmn; 61.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e208.2 \u0026plusmn; 67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e193.3 \u0026plusmn; 67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e177.8 \u0026plusmn; 67.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e161.0 \u0026plusmn; 62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-18mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e171.9 \u0026plusmn; 44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e160.0 \u0026plusmn; 38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e209.6 \u0026plusmn; 50.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e196.5 \u0026plusmn; 46.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e173.3 \u0026plusmn; 50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e159.0 \u0026plusmn; 43.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e175.3 \u0026plusmn; 54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e164.6 \u0026plusmn; 49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 9\u0026ndash;18 mm\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e129.4 \u0026plusmn; 40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e119.9 \u0026plusmn; 34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eChoroidal thickness before and after three monthly injections.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test, comparing choroidal thickness before and after treatment.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRatio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9mm-subfield\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e189.3 \u0026plusmn; 55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e172.3 \u0026plusmn; 52.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.91 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-18mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e171.9 \u0026plusmn; 44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e160.0 \u0026plusmn; 38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRatio of change in choroidal thickness before and after treatment in the posterior area and in the peripheral area.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifference in choroidal thickness changes between aflibercept and faricimab.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe differences in choroidal thickness changes between the aflibercept group (72 eyes) and the faricimab group (73 eyes) were evaluated. The baseline characteristics before and after PSM are shown in \u003cstrong\u003eTable 4\u003c/strong\u003e and \u003cstrong\u003eTable 5\u003c/strong\u003e. Prior to PSM, significant differences were observed in age and nAMD subtype between the two groups. Additionally, the aflibercept group exhibited significantly greater baseline choroidal thickness across all subfields. After applying PSM, no significant differences were found in sex, age, CMT, the proportion of patients with nAMD subtypes, or choroidal thickness in any subfield between the two groups. Subsequent comparisons were conducted using the matched dataset.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e presents the changes in choroidal thickness rates between the aflibercept and faricimab group. Both groups showed significant choroidal thinning across all subfields following treatment. However, in the central 3mm-subfield, the aflibercept group showed a significantly greater reduction in choroidal thickness than the faricimab group. In the 3-9mm-subfield, a marginal difference was observed, with a trend toward a greater reduction in the aflibercept group, although this did not reach statistical significance. No significant differences were found in the 9\u0026ndash;18 mm subfield.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAflibercept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFaricimab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e51 (69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e72.6 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e76.6 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAxial length (mm \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e24.7 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003enAMD subtypes, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003etAMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e46 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e33 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e23 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePNV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;7 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChoroidal thickness (\u0026mu;m\u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e245.9 \u0026plusmn; 73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e217.3 \u0026plusmn; 69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e203.6 \u0026plusmn; 57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e175.3 \u0026plusmn; 49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e250.7 \u0026plusmn; 68.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e218.8 \u0026plusmn; 58.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e226.8 \u0026plusmn; 72.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e194.0 \u0026plusmn; 57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e223.0 \u0026plusmn; 66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e193.7 \u0026plusmn; 65.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e194.5 \u0026plusmn; 72.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e161.4 \u0026plusmn; 56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-18mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e183.5 \u0026plusmn; 49.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e160.5 \u0026plusmn; 35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e221.0 \u0026plusmn; 54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e198.2 \u0026plusmn; 43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e187.8 \u0026plusmn; 59.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e159.1 \u0026plusmn; 35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e185.6 \u0026plusmn; 56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e165.2 \u0026plusmn; 49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 9\u0026ndash;18 mm\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e139.4 \u0026plusmn; 46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e119.5 \u0026plusmn; 30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Patients\u0026rsquo; characteristics before propensity score matching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP-values were calculated using Fisher\u0026rsquo;s exact test for categorical data and the Mann\u0026ndash;Whitney U test for continuous data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: standard deviations,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enAMD: neovascular age-related macular degeneration,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003etAMD: typical age-related macular degeneration, PCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy, RAP: retinal angiomatous proliferation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAflibercept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFaricimab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e37 (77.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e35 (72.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e74.4 \u0026plusmn; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e75.0 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAxial length (mm \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e24.7 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003enAMD subtypes, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003etAMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e27 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e29 (60.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e20 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePNV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChoroidal thickness (\u0026mu;m\u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e226.4 \u0026plusmn; 69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e228.5 \u0026plusmn; 72.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e184.8 \u0026plusmn; 52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e186.3 \u0026plusmn; 48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e228.3 \u0026plusmn; 61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e232.7 \u0026plusmn; 54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e204.3 \u0026plusmn; 65.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e203.1 \u0026plusmn; 53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e203.5 \u0026plusmn; 60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e207.7 \u0026plusmn; 64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e174.9 \u0026plusmn; 67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e173.9 \u0026plusmn; 60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-18mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e168.3 \u0026plusmn; 41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e167.9 \u0026plusmn; 35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e204.5 \u0026plusmn; 44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e208.1 \u0026plusmn; 43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e167.6 \u0026plusmn; 43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e166.3 \u0026plusmn; 35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e172.4 \u0026plusmn; 52.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e172.1 \u0026plusmn; 49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 9\u0026ndash;18 mm\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e128.6 \u0026plusmn; 43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e125.2 \u0026plusmn; 32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Patients\u0026rsquo; characteristics after propensity score matching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP-values were calculated using Fisher\u0026rsquo;s exact test for categorical data and the Mann\u0026ndash;Whitney U test for continuous data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: standard deviations,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enAMD: neovascular age-related macular degeneration,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003etAMD: typical age-related macular degeneration, PCV: polypoidal choroidal vasculopathy, PNV: pachychoroid neovasculopathy, RAP: retinal angiomatous proliferation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAflibercept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFaricimab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en = 48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en = 48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.89 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.95 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.90 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.93 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 3\u0026ndash;9 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.89 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-18mm-subfield\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.93 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.95 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratemporal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.92 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.93 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupranasal 9\u0026ndash;18 mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.95 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfranasal 9\u0026ndash;18 mm\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.93 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDifferences in choroidal thickness change rates between aflibercept and faricimab.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are shown as means with standard deviations. P-values were calculated using the Wilcoxon signed-rank test.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we used WF SS-OCT to evaluate changes in choroidal thickness before and after three consecutive monthly intravitreal injections of anti-VEGF agents in treatment-na\u0026iuml;ve nAMD patients. Significant reductions in choroidal thickness were observed in both central and peripheral areas, demonstrating that the choroidal thinning effect of anti-VEGF therapy extends beyond the macular area. Additionally, the degree of thinning was significantly greater in the central area compared to the peripheral area. Recently, Wakugawa et al. reported choroidal thickness changes after anti-VEGF therapy in nAMD using WF-OCT, demonstrating that overall choroidal thinning was more pronounced in PNV cases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. At our facility, typical PNV cases are treated with half-fluence PDT in combination with anti-VEGF therapy, and therefore only a small number of PNV cases were included in the present study. In addition to the previous findings, we examined differences in choroidal thinning between drugs using PSM and revealed that, in the central 3-mm subfield, the aflibercept group showed significantly greater choroidal thinning compared with the faricimab group. Thus, this study demonstrated, using PSM, that aflibercept induces greater central choroidal thinning than faricimab in nAMD other than PNV.\u003c/p\u003e\u003cp\u003eIn a previous study, we reported a significant reduction in choroidal thickness in the peripheral areas following a single injection of aflibercept combined with half-fluence PDT for PNV at the 3-month follow-up, which yielded similar results [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In that study, the choroidal thickness change rates in PNV were 0.88 in the central 9mm-subfield and 0.91 in the peripheral 9-18mm-subfield. In the current study, following three monthly injections of anti-VEGF agents in nAMD, the corresponding ratios were 0.91 in the central 9mm-subfield and 0.94 in the peripheral 9-18mm-subfield. While direct comparison is limited due to differences in patient backgrounds, both studies consistently show a more pronounced thinning in the central areas.\u003c/p\u003e\u003cp\u003eImportantly, our data do not support a simple model wherein thicker baseline areas thin more after treatment. It has been reported that in healthy eyes, as well as in CSC and PNV, the supratemporal quadrant is the thickest, while the infranasal quadrant is the thinnest. A similar trend was observed in the present nAMD cohort before [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, when examining the choroidal thickness change rates with treatment, no significant difference was found between the supratemporal and infranasal areas, indicating that both areas experienced similar reductions in choroidal thickness. This suggests that the initial choroidal thickness alone does not determine its susceptibility to treatment-induced thinning, but rather that the macular area is inherently more responsive to anti-VEGF effects. In a previous study analyzing choroidal thickness in treatment-na\u0026iuml;ve nAMD patients, we reported that PNV had a more pronounced central choroidal thickening [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These findings indicate that both nAMD onset and treatment can lead to significant changes in the central choroidal structure.\u003c/p\u003e\u003cp\u003eIn nAMD, choroidal thinning after anti-VEGF therapy has been well documented [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This effect is mainly attributed to a reduction in luminal volume rather than stromal tissue [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], along with decreased vascular density of the choriocapillaris [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], suggesting that anti-VEGF therapy reduces choroidal blood flow. In the present study, choroidal thickness in the central 3mm-subfield was significantly more reduced in the aflibercept group than in the faricimab group. Furthermore, faricimab has been reported to have limited effectiveness when switching from aflibercept, particularly in patients with greater baseline choroidal thickness [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our previous analysis comparing outcomes after the loading phase, although no significant difference was found, there was a tendency for aflibercept to induce greater subfoveal choroidal thinning [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These differences between the two drugs may result from the distinct molecular targets each drug inhibits [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Notably, faricimab\u0026rsquo;s additional inhibition of angiopoietin-2 is thought to promote vascular stabilization, possibly mitigating excessive choroidal thinning.\u003c/p\u003e\u003cp\u003ePatients with thicker choroids may have pachychoroid features and exhibit resistance to anti-VEGF therapy [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. If aflibercept more effectively reduces choroidal thickness, it may be the preferred agent in such cases. Additionally, in combination therapy with PDT for PNV, where choroidal thickening is prominent, the aflibercept may be a logical choice. Conversely, thin choroids are considered a risk factor for macular atrophy during treatment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Previous studies have shown that aflibercept has a greater effect on choroidal thinning than ranibizumab [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our hospital, ranibizumab is commonly used to treat RAP. As a result, RAP cases were few in this study; indeed, none remained after PSM. Based on the current findings, which suggest that aflibercept has a greater choroidal thinning effect than faricimab, it may be preferable to use ranibizumab or faricimab for patients with thin choroids at baseline, such as those with RAP. For patients with treatment-resistant RAP already receiving ranibizumab, switching to faricimab may be more beneficial than switching to aflibercept.\u003c/p\u003e\u003cp\u003eThere are some limitations in this study. First, this single-center retrospective study enrolled a relatively small nAMD cohort. A large cohort may better clarify differential drug effects on choroidal thickness. Although WF SS-OCT enabled extended choroidal mapping, the vortex vein ampulla was not captured because it lay outside the imaging field of view. Future studies incorporating this area may provide deeper insight into the underlying pathophysiology of nAMD.\u003c/p\u003e\u003cp\u003eIn conclusion, analysis using WF SS-OCT revealed that anti-VEGF therapy for nAMD reduces choroidal thickness not only in the central region but also in the peripheral areas, with more pronounced thinning observed centrally. Furthermore, after adjustment for patient background using PSM, comparison between aflibercept and faricimab demonstrated that aflibercept induced a greater reduction in central choroidal thickness. These findings underscore the importance of comprehensive choroidal evaluation with WF-OCT to optimize individualized treatment strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYosuke Fukuda and Shoji Notomi designed the study and drafted the manuscript. Yusuke Maehara, Kodai Yuge, Kohei Kiyohara, Yuta Yasaka, and Kenichiro Mori collected data. Satomi Shiose, Keijiro Ishikawa, Yusuke Murakami and Koh-Hei Sonoda critically reviewed the final version of the manuscript. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.com) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Japan Society for the Promotion of Science, the Grant-in-Aid for Scientific Research; KAKENHI, JP25K12836 (to SN) and JP24KJ1780 (to YF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board at Kyushu University, Fukuoka, Japan (REB #26-131) and adhered to the tenets of the Declaration of Helsinki. The requirement for obtaining informed consent was waived, and all data were anonymized prior to data analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGragoudas ES, Adamis AP, Cunningham ET Jr., Feinsod M, Guyer DR (2004) Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351:2805\u0026ndash;2816. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa042760\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa042760\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. 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Graefes Arch Clin Exp Ophthalmol 256:511\u0026ndash;518. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00417-017-3888-2\u003c/span\u003e\u003cspan address=\"10.1007/s00417-017-3888-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"neovascular age-related macular degeneration, anti-vascular endothelial growth factor, angiopoietin-2, wide-field optical coherence tomography, and propensity score matching","lastPublishedDoi":"10.21203/rs.3.rs-7890508/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7890508/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eWhile 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study highlights the importance of considering both central and peripheral choroidal changes when evaluating the impact of different anti-VEGF therapies in nAMD.\u003c/p\u003e","manuscriptTitle":"Wide-Field Choroidal Thickness Changes after Loading-Phase Anti-VEGF Therapy in Treatment- Naïve Neovascular AMD","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-12 09:56:26","doi":"10.21203/rs.3.rs-7890508/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05d3982a-a6df-43fe-a0b3-0df6e5286fcc","owner":[],"postedDate":"November 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:00:26+00:00","versionOfRecord":{"articleIdentity":"rs-7890508","link":"https://doi.org/10.1007/s00417-026-07130-6","journal":{"identity":"graefes-archive-for-clinical-and-experimental-ophthalmology","isVorOnly":false,"title":"Graefe's Archive for Clinical and Experimental Ophthalmology"},"publishedOn":"2026-02-16 15:57:01","publishedOnDateReadable":"February 16th, 2026"},"versionCreatedAt":"2025-11-12 09:56:26","video":"","vorDoi":"10.1007/s00417-026-07130-6","vorDoiUrl":"https://doi.org/10.1007/s00417-026-07130-6","workflowStages":[]},"version":"v1","identity":"rs-7890508","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7890508","identity":"rs-7890508","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}