Fire Series: Expanding Clinical Experience And Early Outcomes Of Dual Pathway Vascular Blockade In Corneal Neovascularisation

To evaluate the early clinical outcomes of faricimab for corneal neovascularisation in routine clinical practice. Through dual pathway inhibition of VEGF A and angiopoietin 2, faricimab may offer therapeutic advantages in disease that is persistent or progressive despite conventional management. Building on prior case reports, this expanded consecutive case series assesses clinical response, tolerability, and potential therapeutic role, providing preliminary evidence for future prospective studies.

This retrospective case series was conducted within specialist corneal services at a UK regional ophthalmology centre. Patients were treated in consultant led outpatient clinics, reflecting contemporary management of complex corneal neovascular disease.

A retrospective observational case series of consecutive patients with persistent or progressive corneal neovascularisation treated with intrastromal and subconjunctival faricimab was undertaken within a specialist corneal service between 2023 and 2025. All eyes exhibited active neovascularisation despite prior conventional therapy. Faricimab was administered in divided doses targeting the most active vascular fronts. Baseline and follow up anterior segment imaging were reviewed. Primary outcomes included changes in neovascular extent and perfusion, corneal clarity, symptom response, and safety. This expanded clinical experience moves beyond isolated case reports and reflects real world therapeutic application.

The cohort represented a broad spectrum of aetiologies, including infection, trauma, autoimmune disease, keratoconus, endothelial failure, and prior graft rejection. Many eyes had complex histories with multiple previous interventions. Most demonstrated early reduction in vessel calibre and perfusion following treatment. In several cases, pronounced regression of active neovascular fronds was observed, accompanied by improved corneal clarity and surface regularity. Faricimab was well tolerated, with no significant ocular or systemic adverse events identified. Quantitative vessel area analysis remains ongoing.

This expanded clinical experience demonstrates that faricimab may represent an important therapeutic advance in corneal neovascularisation that remains challenging to control with established treatments. Dual pathway inhibition of VEGF and angiopoietin 2 appears to drive meaningful regression of pathological vessels and stabilisation of disease activity. Ongoing quantitative analysis will further define treatment durability and magnitude of response, supporting progression to futher prospective evaluation and broader clinical adoption.