The Novel Use Of Vabysmo (Faricimab), A New Anti-Vegf Agent In The Treatment Of New Corneal Neovascularization.

Corneal neovascularization is the invasion of new blood vessels in the cornea, which is a potentially sight-threatening complication. It is a pathological response to various ocular diseases and injuries and can be a challenging condition to manage. This invasion is a result of an imbalance between angiogenic and antiangiogenic factors that normally maintain corneal transparency. The use of an anti-endothelial growth factor (anti-VEGF) could shift that balance and cause corneal vessel regression. Unfortunately, its use for this purpose has not previously been demonstrated. Faricimab an new anti-VEGF agent that is a bispecific antibody, binding to and thus inhibiting both anti-VEGF A and angiopoietin-2 (Ang-2).  

State Funded University hospital corneal service.  

4 patients were identified as having new corneal vascularization that had failed conventional therapy and were at high risk for transplant rejection. Vabysmo 120mg/ml (Faricimab) solution for injection vials Roche Products Ltd was administered to each patient via a 0.05 ml sub-conjunctival injection in divided doses at the sites nearest to the position of new vessels. Anterior segment photographs were taken before and at one weeks and one month to monitor vessel growth. Photographs were then compared over time.  

A range of corneal pathologies were represented in this study. This included: trauma, corneal melt associated with rheumatoid arthritis, bacterial/viral keratitis, endothelial failure and keratoconus. All 4 patients were second corneal grafts. Corneal neovascularization demonstrated a marked regression at 2 weeks, and this was sustained at 2 months.

The promising results in this study show that Faricimab could be a potential effective treatment option for corneal neovascularization in patients who have failed conventional treatment. Interestingly, unlike previous studies of established neovasculisation treated with single binding anti-VEGF agents that found no regression of vessels. This results further supports findings in animal models that dual targeting anti-VEGF A and Ang-2 to be superior due to the verge of inhibition in terms of vascular regression and endothelial cell regression. Further studies are needed to establish its full effect.