Visual and Anatomic Outcomes of Faricimab in Naïve Neovascular Age-Related Macular Degeneration with Subretinal Hemorrhage: A Multi-Centre Retrospective Analysis

Nirojini Sivachandran,1– 5 Patrick Xiang Ji,6 Hannah Khan,7 Lauren Pickel,6 Ohidul Mojumder,8 Aamir A Aziz,7 Huma Khan,8 Humza Sulahria,8 Greggory M Gahn,7,8 Arshad M Khanani7,8 1Toronto Retina Institute, Oakville, ON, Canada; 2School of Medicine, Toronto Metropolitan University, Toronto, ON, Canada; 3Department of Chemistry and Biology, Toronto Metropolitan University, Toronto, ON, Canada; 4Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael’s Hospital, Toronto, ON, Canada; 5University of Ottawa, Department of Ophthalmology, Ottawa, ON, Canada; 6Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 7University of Nevada, Reno School of Medicine, Reno, NV, USA; 8Sierra Eye Associates, Reno, Nevada, USACorrespondence: Nirojini Sivachandran, Toronto Retina Institute, 1425 Cornwall Road, Unit C5, Oakville, ON, L6J7T5, Canada, Tel +1 647 886-5863, Email [email protected]: To evaluate functional and anatomical outcomes of faricimab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) presenting with subretinal hemorrhage (SRH).Subjects and methods: A multicenter retrospective chart review was completed in retina practices in Canada and the United States from June 2022 to September 2025. Treatment-naïve nAMD patients with SRH receiving faricimab were evaluated. Standardized imaging protocols and treat-and-extend guidelines were employed. Primary outcome was visual acuity (VA) change; secondary outcomes included central subfield thickness (CST), pigment epithelial detachment (PED) height, and qualitative assessment of subretinal hyperreflective material (SHRM) and subretinal fibrosis. Outcomes were analyzed following three consecutive loading doses using Friedman statistics for repeated measures. Paired analysis was performed using Wilcoxon signed rank test. Detailed characterization of SRH included measurements of hemorrhage size in disc diameters (DD), location in terms of subfoveal versus extrafoveal, and duration from symptom onset to treatment initiation. Univariate regression analysis was performed to identify predictors of SRH resolution (effect ratio and 95% CI) and visual acuity improvement (odds ratio and 95% CI).Results: This study included 63 treatment-naïve patients with nAMD and SRH (mean age was 81.6 ± 8.2 years; 58.2% females; n = 28 from Canada and n = 35 from United States; mean total follow-up duration was 17.5 ± 6.0 months). Significant VA improvement was observed (Friedman statistic: 26.3, p < 0.00001), with 42.6% of patients gaining ≥ 3 lines of vision after loading doses. CST decreased substantially from 391.8 μm to 249.4 μm (p < 0.00001, z = − 5.48) and mean PED height reduced from 309.6 μm to 110.7 μm (p < 0.00001, z = − 3.51). SHRM and subretinal fibrosis were noted in 81.6% and 25.4% of cases, respectively, at baseline. Of this, 70% had resolution of SHRM and 50% had improvement in fibrosis, at last follow up visit. Univariate analysis of predictors of faricimab injection account to achieve SRH resolution in n = 33 patients identified three significant predictors: SHRM-presence at baseline (effect ratio = 0.531, 95% CI 0.399– 0.707, p < 0.0001), combined intraretinal fluid (IRF) and subretinal fluid (SRF) (effect ratio = 1.43, 95% CI 1.09– 1.87, p = 0.011), and non-Caucasian ethnicity (effect ratio = 1.45, 95% CI 1.03– 2.04, p = 0.031). Analysis of predictors of VA improvement > 3 lines did not reveal any clinically meaningful associations.Conclusion: This study demonstrates faricimab’s efficacy in nAMD with SRH, a challenging phenotype traditionally associated with poor visual prognosis. The dual-pathway inhibition of VEGF-A and Ang-2 achieved rapid hemorrhage clearance and meaningful vision gains, offering clinical hope for this high-risk population.Keywords: neovascular age-related macular degeneration, subretinal hemorrhage, faricimab, anti-VEGF therapy, anti-Ang-2, dual-inbhition, visual improvement