[Management of patients with treatment-resistant neovascular age-related macular degeneration]

This study evaluates the efficacy of intravitreal injections (IVI) of faricimab in patients with neovascular age-related macular degeneration (nAMD) and retinal pigment epithelium detachment (RPED) resistant to other anti-VEGF agents.

The study included 61 patients (61 eyes) with nAMD previously treated with aflibercept and/or brolucizumab IVIs. Three groups were formed: group 1 received aflibercept IVI (32 eyes), group 2 received brolucizumab IVI (14 eyes), and group 3 received aflibercept followed by brolucizumab IVI (15 eyes). All patients received four monthly loading injections of faricimab (Vabysmo, F. Hoffmann-La Roche Ltd, Switzerland) at a dose of 0.05 ml (6 mg), with disease activity assessed at month 4. For active disease, injections were administered at 4-week intervals; for inactive disease, injections were done at 8-week intervals.

In group 1, significant improvement was observed in all parameters by month 4 (p<0.05), accompanied by an increase in visual acuity. Similar findings were recorded at month 6. In group 2, no statistically significant change in best-corrected visual acuity (BCVA) was found; however, a notable reduction in central retinal thickness and maximum RPED height was seen at both months 4 and 6, due to decrease in fibrous and fibrovascular layers (p<0.05). No signs of prechoroidal cleft were detected. In group 3, monthly IVI resulted in reductions in all parameters except prechoroidal cleft height (p>0.05), although by month 6 the values returned to baseline pre-treatment levels (p>0.05).

Intravitreal injections of faricimab may prove to be an effective treatment for nAMD in patients resistant to other anti-VEGF agents.