Short-term real-world outcomes of switching to faricimab in anti-VEGF-refractory retinal vein occlusion: a prospective study

To evaluate short-term real-world outcomes after switching to faricimab using a modified treat-and-extend (TAE) regimen with a single loading dose in patients with retinal vein occlusion (RVO) refractory to prior anti-VEGF therapy. In this prospective study, 27 eyes of 27 patients with macular edema (ME) secondary to RVO and persistent intraretinal fluid (IRF) and central subfield thickness (CST) ≥ 270 μm despite ≥ 3 prior anti-VEGF injections at treatment intervals ≤ 6 weeks were switched to faricimab. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, including CST, IRF, and subretinal fluid (SRF), were assessed from baseline (1st faricimab injection) until 3rd faricimab injection (final visit). Outcomes were analyzed for all RVO combined and stratified by central (CRVO) and branch retinal vein occlusion (BRVO). In the all RVO combined cohort, median BCVA improved significantly from 0.2 logMAR to 0.1 logMAR (p = 0.022), and median CST decreased from 291 μm to 268 μm (p < 0.001) over a mean follow-up of 11.7 weeks. The proportion of eyes with IRF was significantly reduced (p < 0.001), and a dry macula was achieved in 48.1% of eyes at the final visit. The mean treatment interval increased significantly from 4.6 to 7.3 weeks, with an intended interval extension achieved in 88.9% of eyes. After stratification, both CRVO and BRVO subgroups showed significant CST reduction and significant treatment interval extension, while BCVA improved numerically in both subgroups without reaching statistical significance. No safety-related adverse events were observed. In real-world practice, switching to faricimab using a modified TAE regimen with a single loading dose appears to be effective in RVO patients refractory to prior anti-VEGF therapy, yielding significant functional improvement with early interval extension and no safety concerns. German Clinical Trials Register (DRKS) registration ID: DRKS00036984.