Faricimab Effectively Resolves Intraretinal Fluid and Preserves Vision in Refractory, Recalcitrant, and Nonresponsive Neovascular Age-Related Macular Degeneration

Purpose: To evaluate the functional and anatomic outcomes of faricimab treatment in patients with neovascular age-related macular degeneration (nAMD) who are unresponsive to other anti-vascular endothelial growth factor (VEGF) therapies.Methods: A retrospective interventional study was conducted on patients with refractory nAMD who were initially treated with intravitreal bevacizumab, ranibizumab, or aflibercept. These patients were switched to monthly faricimab injections. The central subfield thickness (CST), intraretinal fluid (IRF) or subretinal fluid (SRF) height, and visual acuities were compared before and after faricimab treatment.Results: A total of 13 eyes (eight right eyes and five left eyes) from 11 patients were followed for 10.4 & PLUSMN; 6.9 months after bevacizumab treatment and 40.3 & PLUSMN; 28.7 months after aflibercept treatment before switching to faricimab. The follow-up time for patients receiving a mean number of 3.7 & PLUSMN; 1.3 faricimab injections was 3.4 & PLUSMN; 1.2 months. The overall median CST was reduced by 18pm (p=0.001) from 342pm to 318pm, along with a reduction of 89pm (p=0.03) in IRF/SRF height from 97pm to 40pm. Following three consecutive injections, the CST showed a significant reduction of 21.5pm (p=0.004) from 344pm to 322.5pm, and IRF/SRF height was reduced by 89pm (p=0.03) from 104pm to 18.5pm. The intraretinal fluid size decreased and leakage stopped, as seen on fluorescein angiography. Visual acuity remained stable after switching to faricimab treatment (0.59 & PLUSMN; 0.45 logMAR vs 0.58 & PLUSMN; 0.45 logMAR, p=1).Conclusions: Faricimab has proven to be an effective treatment for nAMD patients resistant to other anti-VEGF agents. It demonstrates significant anatomical improvement and vision preservation in this challenging patient population.