From the Guidelines
Vabysmo (faricimab) is not recommended as a first-line treatment for central serous chorioretinopathy (CSC) due to the lack of clinical trials specifically evaluating its efficacy for this condition. CSC is characterized by fluid accumulation under the retina, often resolving spontaneously within 3-6 months. First-line management typically involves observation for acute cases, while chronic CSC may be treated with photodynamic therapy, laser photocoagulation, or off-label anti-VEGF agents like bevacizumab or ranibizumab 1.
According to the most recent evidence-based treatment guideline for central serous chorioretinopathy, half-dose (or half-fluence) photodynamic therapy appears to be the safest and most effective treatment for chronic CSC 1. The guideline suggests that treating hyperfluorescent areas on indocyanine green angiography that correspond to the area of focal leakage on fluorescein angiography and sub-retinal fluid on optical coherence tomography can lead to complete SRF resolution in a significant number of patients.
While Vabysmo, which targets both VEGF-A and angiopoietin-2 pathways, is approved for wet age-related macular degeneration and diabetic macular edema, its dual mechanism of action might theoretically benefit CSC patients by reducing vascular leakage. However, clinical trials specifically evaluating Vabysmo for CSC are lacking, and patients with CSC should consult with a retina specialist to discuss established treatment options rather than pursuing Vabysmo as a first-line therapy 1. If considering Vabysmo, it would be as an off-label use requiring careful discussion of potential benefits, risks, and alternatives.
Some key points to consider when treating CSC include:
- The use of half-dose (or half-fluence) photodynamic therapy as the most effective treatment option available 1
- The importance of evaluating the patient's specific condition, including the presence of focal or diffuse leakage, to determine the best course of treatment 1
- The potential benefits and risks of off-label use of anti-VEGF agents, including Vabysmo, for treating CSC 1
- The need for careful discussion and informed consent with the patient prior to treatment, especially when considering off-label use of a medication 1
From the Research
Treatment Options for Central Serous Chorioretinopathy (CSC)
- The effectiveness of various treatments for CSC, including laser treatment, photodynamic therapy (PDT), and intravitreal injection of anti-vascular endothelial growth factor agents, has been studied 2, 3, 4, 5, 6.
- PDT and micropulse laser treatment appear to be the most promising interventions for CSC 2, 3, 4, 5.
- Half-dose or half-fluence photodynamic therapy is considered the most effective therapeutic option for chronic central serous chorioretinopathy, with conventional laser therapy being an acceptable alternative in certain cases 5, 6.
Efficacy of Specific Treatments
- Photodynamic therapy (PDT) using half-dose verteporfin has been shown to lead to a significant decrease in subretinal fluid (SRF) in patients with acute CSCR 6.
- Subthreshold micropulse laser therapy has also been found to be effective in improving best corrected visual acuity (BCVA) and promoting SRF resolution in patients with chronic CSCR 5.
- VEGF antagonists, such as intravitreal anti-VEGF injections, have not been found to be effective in the absence of choroidal neovascularization 5, 6.
- Mineralocorticoid receptor antagonists, such as eplerenone, have not been demonstrated to be efficacious for the treatment of chronic CSCR 6.
Vabysmo (Faricimab) for CSC
- There is no direct evidence in the provided studies to support the use of Vabysmo (faricimab) for the treatment of central serous chorioretinopathy (CSC) 2, 3, 4, 5, 6.
- The studies primarily focus on the efficacy of PDT, laser treatments, and other interventions for CSC, without mentioning Vabysmo (faricimab) as a treatment option.