Real-world outcomes after switching to faricimab in treatment-resistant neovascular AMD: Short-term response and 12-month follow-up

Aims To assess the efficacy and safety of faricimab in neovascular age-related macular degeneration (nAMD) resistant to anti-VEGF therapies. Methods This retrospective study evaluated nAMD patients with persistent fluid despite anti-VEGF treatments (aflibercept or ranibizumab; mean injection interval of 4.63 ± 0.78 weeks), switched to faricimab and treated with three monthly injections. Data included demographics, baseline macular characteristics and prior treatments. Outcomes focused on anatomical changes (central macular thickness (CMT), pigment epithelial detachment (PED) height, fluid resolution), predictive factors for response, and fluid-free intervals. Results Seventy-five eyes from 64 patients (mean age 81.5 years) with predominantly type 1 macular neovascularization (84%) and extensive prior anti-VEGF exposure (mean 43.7 injections) were analyzed. Complete dryness was achieved in 58.67% of cases, with partial dryness in 28%. CMT and PED height showed significant reductions (p < 0.0001), while visual acuity remained stable throughout follow-up. In a selected subgroup of complete responders with at least 12-month follow-up (42/75 eyes), CMT reduction was maintained, but these longer-term findings should be interpreted cautiously because of potential selection bias. In cases with complete fluid resolution, the fluid-free interval averaged six weeks. Conclusion Faricimab offers notable anatomical improvements in nAMD resistant to anti-VEGF therapy, with stable visual acuity. In this heavily pretreated, treatment-resistant population, treatment intervals nevertheless remained short, averaging less than six weeks (5.34 ± 1.31 weeks), so the main benefit appears anatomical, with limited evidence for functional gain or reduced treatment burden.