Faricimab for Refractory Neovascular Age-Related Macular Degeneration: Retrospective Real-World Evidence from India

To evaluate the anatomical and functional outcomes of faricimab in eyes with refractory neovascular age-related macular degeneration (nAMD) in a real-world Indian cohort over a six-month period.

In this retrospective, multicenter study, 24 eyes with refractory nAMD were switched to faricimab on a pro-re-nata regimen between January 2024 and December 2024. Patients underwent monthly evaluation for three months, then per physician discretion, with measurement of best-corrected visual acuity (BCVA), central foveal thickness (CFT), and proportions of eyes with intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED).

The cohort's mean age was 68.1 (±10.6) years, and prior to switching had received an average of 11.4 (±9.1) anti-VEGF injections. During the six-month period, eyes underwent a mean of 2.63 (± 1.34) faricimab injections (range, 1-5): 25.0% received one injection, 29.2% two, 16.7% three, 16.7% four, and 12.5% five. Mean BCVA improved from 0.66 (±0.4) logMAR at baseline to 0.47 (±0.34) at month 1, 0.35 (±0.32) at month 2, and 0.27 (±0.27) at months 3 and 6 (P≤0.0003). Mean CFT decreased from 471.1 (±246.4) µm to 337.3 (±198.3) µm (month 1), 265.1 (±90.7) µm (month 2), 217.7 (±41.3) µm (month 3), and 209.4 (±36.0) µm (month 6) (P<0.0001). SRF resolved in 90.9% of affected eyes (P<0.001), IRF in 87.5% (P=0.0006), and PED in 54.5% (P=0.32), with complete fluid resolution in 83.3% of eyes (P=0.00002). No ocular or systemic adverse events occurred.

In this real-world Indian cohort of refractory nAMD, faricimab delivered robust visual gains, significant CFT reduction, and high rates of fluid resolution, with over half of eyes requiring ≤2 injections over six months, supporting its role as an effective switch therapy. Further prospective studies are warranted to optimize dosing intervals and long-term outcomes.