One-year outcomes of faricimab for neovascular age related macular degeneration with OCT angiography: focus on resistant and refractory cases.

Purpose: To investigate the 12-month effectiveness and safety of intravitreal faricimab (IVF) in patients with neovascular age-related macular degeneration (nAMD) resistant to previous anti-VEGF treatment.

Methods: Prospective, monocentric study including consecutive patients with resistant/refractory nAMD switched to IVF between July 2023 and November 2024. Primary endpoints were safety, best corrected visual acuity (BCVA), central subfield thickness (CST), and subfoveal choroidal thickness. Secondary endpoints included changes in optical coherence tomography (OCT) and OCT angiography biomarkers: fluid prevalence, pigment epithelial detachment (PED) height, and vascular densities. All patients received four monthly loading doses of faricimab, with subsequent treat-and-extend regimen.

Results: The study included 30 eyes of 30 patients. Mean follow-up was 14.2 ± 1.9 months and no adverse events were reported. BCVA significantly improved from 0.77 to 0.62 LogMAR at the end of the study period (p = 0.009), with 67% of eyes showing stable vision. CST significantly decreased from baseline (-57 μm on average, p < 0.001), along with PED height which showed its main decrease during the loading phase. Forty-seven percent of eyes achieved complete macular dryness at week 16, with significant reduction in terms of subretinal fluid (SRF) and intraretinal fluid (IRF) prevalence. At the end of the study, 90% of patients achieved treatment intervals of at least q8w, with 27% of eyes being on q12w. Finally, no changes in superficial/deep vessel densities were observed.

Conclusion: Faricimab demonstrated efficacy and safety in refractory/resistant nAMD, with significant improvements in structural outcomes and stable/improved visual acuity. Extended treatment intervals suggest a potential reduction in treatment burden.