Advances in Polypoidal Choroidal Vasculopathy (PCV) Management: Emerging Evidence for Faricimab and Aflibercept 8 mg

INTRODUCTION: Polypoidal choroidal vasculopathy (PCV) is a major subtype of neovascular age-related macular degeneration (nAMD), particularly prevalent in Asian and pigmented populations. While anti-vascular endothelial growth factor (anti-VEGF) therapy has improved outcomes, limitations in durability and incomplete polypoidal lesion regression remain. This review provides an updated synthesis of emerging evidence on newer anti-VEGF agents in PCV management. METHODS: This narrative review synthesizes recent evidence in PCV management, integrating data from clinical trials and emerging real-world studies, with a focus on newer anti-VEGF agents including faricimab (Vabysmo, Roche/Genentech)and aflibercept 8 mg (Eylea HD, Regeneron). RESULTS: Faricimab, a bispecific antibody targeting VEGFA and angiopoietin-2 (Ang-2), demonstrated non-inferior efficacy compared with aflibercept 2 mg administered every 8 weeks in the TENAYA/LUCERNE trials, with over 70% of patients achieving dosing intervals of ≥ 12 weeks. The SALWEEN study further evaluated faricimab in 135 patients with PCV, reporting robust visual gains (+ 8.9 letters), 61% polypoidal lesion regression, and over 80% of patients achieving ≥ 12-week dosing intervals at 48 weeks. Aflibercept 8 mg, evaluated in the PULSAR trial, demonstrated comparable safety and efficacy with improved anatomical drying and extended dosing intervals (12-16 weeks) compared with aflibercept 2 mg. In a subgroup analysis of 139 eyes with indocyanine green angiography (ICGA)-confirmed PCV, outcomes were consistent with the overall study population, with similar visual and anatomical improvements but reduced injection burden. More than 80% of eyes achieved dosing intervals of ≥ 12 weeks at 2 years. CONCLUSIONS: Faricimab and aflibercept 8 mg represent important advances in PCV management, offering more durable treatment options and reducing treatment burden. However, important gaps remain, including limited real-world data for aflibercept 8 mg, absence of head-to-head PCV-specific trials, and uncertainty regarding long-term recurrence and lesion inactivation. These findings support a shift toward increasingly individualized and durable treatment strategies in PCV.