Faricimab for treatment-naïve nAMD: 1- and 2-year outcomes and PS-OCT polarimetric entropy

BACKGROUND: To evaluate 1- and 2-year real-world outcomes of intravitreal faricimab for treatment-naïve neovascular age-related macular degeneration (nAMD) and to explore factors associated with visual acuity change, including polarization-sensitive OCT (PS-OCT)-derived polarimetric entropy (PE). METHODS: This retrospective single-center study included 27 treatment-naïve nAMD eyes initiating faricimab; all eyes were evaluable at 1 year (n = 27) and 18 at 2 years (n = 18). BCVA (logMAR), central retinal thickness (CRT), PE, and entropy-defined HRF-like foci (HEF)-related metrics were assessed. Associations with ΔlogMAR (post-pre) were examined using multivariable linear regression. Prespecified baseline-BCVA-adjusted and EZ-adjusted sensitivity models were additionally performed. EZ integrity was graded at the fovea and included in sensitivity analyses. RESULTS: BCVA improved from 0.40 ± 0.28 to 0.20 ± 0.23 at 1 year (P < 0.0001). In the 2-year cohort, BCVA improved from 0.35 ± 0.28 to 0.15 ± 0.20 at 1 year (P = 0.0003) and 0.12 ± 0.17 at 2 years (P = 0.0004). CRT decreased from 337.5 ± 159.8 to 186.7 ± 47.3 µm at 1 year (P < 0.0001) and from 337.3 ± 185.9 to 185.1 ± 46.4 µm at 1 year (P = 0.0019) and 181.2 ± 60.9 µm at 2 years (P < 0.0001). Mean PE increased at 1 year (0.44 ± 0.06 to 0.46 ± 0.05; P < 0.0001) but not from baseline to 2 years (P = 0.81). In multivariable analyses, ΔPE was associated with 1-year ΔlogMAR (β; - 2.7 to - 2.8; P ≤ 0.01) together with MNV subtype, whereas at 2 years the incremental association of ΔPE was attenuated in baseline-adjusted and EZ-adjusted sensitivity analyses in the 2-year completer cohort. CONCLUSIONS: Faricimab treatment was associated with sustained functional and anatomical improvement in treatment-naïve nAMD. PE change may serve as a complementary imaging marker associated with visual improvement, particularly at 1 year, while longer-term associations warrant confirmation in larger cohorts.