Association between baseline central retinal thickness and short-term anatomic response to faricimab in difficult-to-control nAMD: a real-world study

Abstract Background This study aimed to evaluate the real-world efficacy and safety of faricimab in patients with difficult-to-control neovascular age-related macular degeneration (nAMD) and to identify baseline imaging biomarkers associated with short-term anatomical response. Methods This retrospective study included 32 eyes from 30 patients with difficult-to-control nAMD who switched to faricimab following a suboptimal response to prior aflibercept therapy. All patients received three intravitreal faricimab injections. Swept-source optical coherence tomography angiography (SS-OCTA) imaging was performed at baseline and post-treatment. Univariable Firth’s penalized likelihood logistic regression combined with patient-level clustered bootstrap resampling was used to identify baseline biomarkers associated with a good anatomical response. Results After three faricimab injections, best-corrected visual acuity (BCVA) improved significantly from 0.82 to 0.71 logMAR ( p = 0.039). Significant reductions were observed in central retinal thickness (CRT: 340.50 to 223.50 μm, p < 0.001), subfoveal choroidal thickness (SFCT: 277.52 to 245.01 μm, p = 0.008), and pigment epithelial detachment (PED) volume (0.63 to 0.35 mm³, p = 0.003). The proportions of eyes with subretinal hyperreflective material (SHRM; 93.75% to 68.75%, p = 0.008), subretinal fluid (SRF; 75.00% to 37.50%, p < 0.001), and intraretinal fluid (IRF; 56.25% to 21.88%, p < 0.001) decreased significantly. The foveal avascular zone (FAZ) circularity index (FAZ-CI) increased (0.80 to 0.83, p = 0.014), whereas flow density in the 300-µm parafoveal annulus decreased (21.51% to 15.64%, p < 0.001). Adverse events were infrequent and mild. Thicker baseline CRT was the sole biomarker significantly associated with a good anatomical response (odds ratio [OR] = 1.65 per 100 μm increase; 95% confidence interval [CI] 1.06–3.25; p = 0.020; area under the curve [AUC] = 0.78). Conclusions Faricimab demonstrated favorable short-term functional and anatomical efficacy in difficult-to-control nAMD. Baseline CRT showed a preliminary exploratory association with short-term anatomical response, requiring future research to determine its clinical utility.