Clinical Outcomes of Faricimab Therapy in Treatment-resistant Polypoidal Choroidal Vasculopathy: A Real-world Study

Purpose: This study aimed to evaluate the functional and anatomical effects of switching to faricimab in patients with polypoidal choroidal vasculopathy (PCV) refractory to other anti-vascular endothelial growth factor (anti-VEGF) therapy.Methods: This retrospective study analyzed the medical records of patients with PCV who were switched to faricimab.Prior to the initial faricimab injections, all patients underwent spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography.Changes in best-corrected visual acuity were recorded, while anatomic outcomes including central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachment (PED) height, and presence of retinal fluid were measured by SD-OCT.Results: A total of 19 eyes from 17 patients were included.The mean age was 71.3 7.3 years.Prior to faricimab treatment, patients had received a mean of 20.2 9.5 (range 8-40) injections.The mean follow-up duration from the initial faricimab injection was 38.6 17.6 weeks (range 16-68).At baseline, the mean CMT, PED height, and SFCT were 443.8 220.9 m, 331.0 389.3 m, and 289.5 148.9 m, respectively.During faricimab treatment, significant anatomical improvements were observed in CMT (314.9 110.5 m), PED height (158.0 152.5 m), and SFCT (239.0 110.1 m) (all p < 0.05).A good PED response (50% reduction in height) was achieved in 7 eyes (41.1%), a partial response (<50% reduction) in 7 eyes (41.1%), and a poor response (no change in height) in 3 eyes (17.6%).At the final visit, 11 eyes (57.8%) achieved a dry macula, representing the absence of intraretinal or subretinal fluid.Conclusions: Faricimab may represent a safe and effective treatment strategy for improving anatomical outcomes, though larger patient cohorts are required to validate these findings.This drug could emerge as a valuable alternative for patients experiencing PCV refractory to other anti-VEGF injections.