Switching to faricimab in anti-VEGF-refractory retinal vein occlusion: nine-month prospective real-world outcomes under a modified treat-and-extend regimen

PURPOSE: To evaluate nine-month outcomes after switching to faricimab in anti-VEGF-refractory retinal vein occlusion (RVO) under a modified treat-and-extend (T&E) regimen. METHODS: In this prospective real-world study, 34 eyes of 34 patients with macular edema (ME) secondary to RVO were switched to faricimab. Eligibility required persistent center-involving intraretinal fluid (IRF) across the three most recent treatment visits, central subfield thickness (CST) ≥ 270 μm at switching, and ≥ 3 prior anti-VEGF injections with the three most recent intervals of 4-6 weeks and no ability to extend beyond six weeks. Treatment followed a modified T&E regimen with a single loading dose. Best-corrected visual acuity (BCVA), CST, OCT biomarkers, and treatment intervals were evaluated through the fifth injection visit. Baseline-to-final comparisons were supplemented by longitudinal mixed-effects analyses. RESULTS: Median BCVA improved from 0.2 to 0.1 logMAR (p = 0.04), and median CST decreased from 298 to 270 μm (p = 0.003). IRF decreased from 100% to 47% (p < 0.001) and hyperreflective foci from 53% to 21% (p = 0.003). Mean treatment intervals increased from 4.7 ± 0.9 to 9.5 ± 3.0 weeks (p < 0.001), with extension possible in 94% of eyes. Both central and branch RVO subgroups showed significant interval extension. No intraocular inflammation or other serious ocular adverse events occurred. CONCLUSIONS: Switching to faricimab was associated with sustained anatomical improvement, modest functional benefit, and clinically meaningful interval extension. These findings support a response-guided modified T&E switch strategy without a conventional loading phase in treatment-intensive RVO. CLINICAL TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00036984.