Improved functional and morphological outcomes with faricimab in nAMD eyes with poor response to prior intravitreal anti-VEGF therapy.

INTRODUCTION

Neovascular age-related macular degeneration (nAMD) is a major cause of vision loss in older adults. While anti-VEGF therapies have improved management by suppressing abnormal blood vessel growth, a substantial subset of patients show poor functional as well as morphological responses and require frequent injections. Faricimab (Vabysmo®), a bispecific inhibitor targeting VEGF-A and angiopoietin-2 (Ang-2), has shown promise in achieving more durable disease control.

METHODS

This retrospective study included 48 eyes from 47 nAMD patients previously treated with ranibizumab or aflibercept, who were switched to faricimab due to poor treatment response. Evaluations occurred at four time points, assessing best-corrected visual acuity (BCVA), intraretinal (IRF) and subretinal fluid (SRF), subretinal pigment epithelium fluid and fibrosis, central subfield thickness (CST), and central subfield volume (CSV) using spectral-domain OCT. Dosing intervals and patient-reported outcomes were also recorded.

RESULTS

BCVA improved consistently, with mean logMAR improving from 0.54 to 0.40, reflecting a gain of 1.4 Snellen lines. Dosing intervals extended from a median of 5 to 8 weeks, with over one-third of eyes reaching intervals of 10 weeks or more. Significant reductions in IRF, SRF, CST as well as CSV were observed (p < 0.05) with a quarter of eyes showing no intra- or subretinal fluid at the fourth faricimab injection. Three patients were switched back to their previous anti-VEGF treatment due to a decline in BCVA.

DISCUSSION: The findings suggest Faricimab as an effective option for nAMD patients who respond inadequately to prior anti-VEGF therapies, offering both functional and anatomical improvements. Extended intervals reduce treatment burden, indicating faricimab's potential to enhance disease control and patient quality of life in real-world settings.