Functional and Anatomic Outcomes at 12 Months After Switching to Faricimab in Treatment-Recalcitrant Neovascular Age-Related Macular Degeneration

Purpose: To evaluate functional and anatomic outcomes over 12 months in patients with recalcitrant neovascular age-related macular degeneration (nAMD) whose treatment was transitioned to faricimab. Methods: This retrospective observational study included 36 patients (41 eyes) with treatment-recalcitrant nAMD previously treated with bevacizumab, ranibizumab, or aflibercept. Patients received 4 monthly intravitreal faricimab injections followed by individualized treatment intervals. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) images, and swept-source OCT angiography images were assessed at baseline, 6 months, and 12 months. Anatomic features evaluated included intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), macular neovascularization (MNV), and geographic atrophy (GA). Results: Mean (±SD) BCVA remained stable over the 12-month period (baseline, 0.289 ± 0.350 logMAR; 12 months, 0.306 ± 0.394 logMAR; P = .41). Treatment intervals increased from a mean of 5.29 weeks prior to the switch to faricimab to 7.58 weeks afterward. Anatomically, the proportion of eyes without IRF or SRF improved from 34.14% at baseline to 74.68% at 12 months. A significant reduction in PED maximum height was observed at 6 months, along with decreases in mean PED height and volume. MNV metrics demonstrated a significant decline in vessel area density at 6 months (P = .031), although no sustained significant changes were observed at 12 months. GA size increased by a mean of 0.41 mm²/year over the study period (P = .026). Conclusions: Switching to faricimab in treatment-recalcitrant nAMD maintained visual acuity, improved anatomic outcomes, and significantly extended injection intervals. These findings underscore faricimab's efficacy in managing refractory nAMD cases.