Switching from Aflibercept to Faricimab in the Treatment of Neovascular Age-Related Macular Degeneration: Short-Term Results from Real-Life Study

<b>Purpose:</b> To evaluate anatomical and functional outcomes after switching from aflibercept to faricimab in patients with neovascular age-related macular degeneration (nAMD) with suboptimal response. <b>Methods:</b> This retrospective study included 72 eyes of 66 patients with nAMD previously treated with intravitreal aflibercept using a treat-and-extend regimen. Indications for switching included persistent retinal fluid, pigment epithelial detachment (PED), lack of best-corrected visual acuity (BCVA) improvement, or inability to extend treatment intervals beyond four weeks. Patients received three monthly loading doses of faricimab followed by individualized 8- to 16-week dosing. Follow-up comprised six visits over a mean of 8.5 ± 1.4 months. Outcomes included BCVA (logMAR), retinal morphology (subretinal fluid-SRF; intraretinal fluid-IRF; pigment epithelial detachment-PED), central subfoveal thickness (CST), and treatment interval changes. <b>Results:</b> Switching to faricimab led to significant short-term anatomical improvement, primarily reduction in subretinal fluid (<i>p</i> < 0.0001), with maximal effect during the loading phase. Resolution of SRF was significant at the end of the follow up; however, IRF changes were transient and not sustained beyond three months. PED reduction reached borderline significance (<i>p</i> = 0.0455). CST decreased during the loading phase (<i>p</i> < 0.0001) but returned to baseline thereafter. BCVA improved only after loading (<i>p</i> = 0.0287) but not at final follow-up. Treatment intervals were extended by a mean of ~2 weeks (<i>p</i> < 0.0001), increasing in 80% of eyes. Eyes with fewer prior injections and better baseline BCVA achieved superior final visual outcomes. <b>Conclusions:</b> Switching to faricimab provides short-term anatomical benefits and treatment-interval extension without sustained visual gain. Functional improvements tended to be greater in patients with fewer injections and shorter treatment duration prior to switch.