Real-World Outcomes of Switching to Faricimab in Treatment-Experienced and Resistant Neovascular Age-Related Macular Degeneration: A Single-Centre Retrospective Study

Purpose: To evaluate anatomical, functional, and treatment burden outcomes of Faricimab in neovascular age-related macular degeneration (nAMD) patients with persistent disease activity despite prior anti-VEGF therapy. Patients and Methods: Single-centre retrospective study of 67 eyes switched to Faricimab (November 2022–December 2024). This cohort was unable to be extended beyond 4– 6-week intervals on existing anti-VEGF therapy. All patients received three monthly loading doses followed by treat-and-extend regimen. Primary outcomes: central macular thickness (CMT), best-corrected visual acuity (BCVA), macular dryness over eight injections, and treatment interval extension. Results: The cohort had received mean 33 (range 10– 78) prior anti-VEGF. Baseline mean BCVA was 0.42 logMAR (SD ± 0.28) and mean CMT was 244.5 μm (SD ± 62.2). Statistically significant CMT reduction occurred by injection 8 (− 16.9 μm, p=0.0084). Complete macular dryness peaked by the time of third injection (43.3%) then declined to 32.8% at injection 8 (p=0.0089). Visual acuity remained unchanged (p=0.6043) with no correlation to CMT change (p=0.172). Treatment interval extension was achieved in 46.3% of patients (p=0.002). Dryness at injection 3 after switching to Faricimab did not predict treatment extension (p=0.217). Two patients (0.36% of total injections, 2/548) developed sterile intraocular inflammation requiring discontinuation. Conclusion: Faricimab switching achieves statistically significant but modest anatomical improvement in heavily pretreated nAMD with meaningful treatment burden reduction in 46.3% of eyes. Our analysis revealed treatment burden did not indicate the potential for treatment interval extension. Keywords: Faricimab, anti-VEGF switching, treatment-resistant nAMD, treat-and-extend