Faricimab for recalcitrant neovascular age-related macular degeneration: a real-life study following aflibercept nonresponse.

OBJECTIVE: To evaluate anatomical and functional outcomes following a switch to intravitreal faricimab in patients with active, recalcitrant neovascular age-related macular degeneration (nAMD) previously treated with aflibercept in a real-life setting.

DESIGN: A retrospective, observational, single-centre study.

METHODS: Demographic data and prior intravitreal treatment (IVT) history were collected. Best-corrected visual acuity (BCVA) and disease activity were assessed using optical coherence tomography (OCT), including fluid compartments: intraretinal fluid, subretinal fluid (SRF), pigment epithelial detachment, and subretinal hyperreflective material.

RESULTS: A total of 161 eyes from 145 patients (mean age: 80.1 ± 7.8 years) were included. Mean prior IVT duration was 2.9 ± 2.5 years. All eyes were active at the time of switching, with 82.0% showing persistent SRF. Disease inactivation occurred in 42.9% of eyes after the switch, more frequently in eyes with shorter prior treatment duration. BCVA remained stable throughout the follow-up. SRF resolved in 50.8% of eyes, with 52.2% achieving resolution after a single injection. Mean treatment intervals increased significantly in inactivated eyes (+4.9 ± 5 weeks). Disease relapse occurred in 54.6% of the initially inactivated eyes. No adverse events were reported.

CONCLUSIONS: Switching to faricimab may offer a valuable therapeutic option for recalcitrant nAMD, particularly in eyes with persistent SRF, providing improved anatomical outcomes while maintaining visual acuity in real-life practice. Prospective studies are warranted to better define response profiles and guide personalized treatment strategies.