VEGF-inhibitor switch trial in poor-responsive neovascular age-related macular degeneration: assessing brolucizumab vs. faricimab: VISTA study

Purpose To compare short-term (12 weeks) and long-term (48 weeks) anatomical and functional outcomes after switching to brolucizumab (BRZ) or faricimab (FAR) under a treat-and-extend (TAE) regimen without an initial loading phase in eyes with poor-responsive neovascular age-related macular degeneration (nAMD). Methods This retrospective, single-center study included eyes with poor-responsive nAMD previously treated with anti-VEGF agents that were switched to BRZ or FAR between 2022 and 2025. Functional outcomes (best-corrected visual acuity [BCVA]) and anatomical parameters (central subfield thickness [CST], fibrovascular pigment epithelial detachment [fvPED] height, intraretinal/subretinal fluid [IRF/SRF], subretinal hyperreflective material [SHRM]) were assessed at baseline, week 12, and week 48. Injection frequency, interval extension, and safety were recorded. Results Sixty-six eyes (41 BRZ, 25 FAR) were included. At 12 weeks, BCVA remained stable (BRZ 0.49 logMAR, FAR 0.40; p = 0.10). CST decreased significantly in both groups, greater with BRZ (243 μm vs. 280 μm; p = 0.04). Mean injections (2.95 vs. 3.2; p = 0.12) and intervals (5.9 vs. 5.6 weeks; p = 0.90) were comparable; no intraocular inflammation (IOI) occurred. At 48 weeks, BCVA was numerically better with FAR (0.20 vs. 0.49 logMAR; p = 0.08). CST reduction was sustained andcomparable (259 µm vs. 260 µm; p = 0.50). FAR achieved greater fvPED reduction (110 µm vs. 160 µm; p = 0.022). BRZ required fewer injections (6.3 vs. 7.2; p = 0.009) with similar intervals (9.4 vs. 9.9 weeks; p = 0.80). Mild IOI occurred in two BRZ eyes (4.9%) and none with FAR. Conclusions In poor-responsive nAMD, switching to BRZ or FAR under a TAE regimen without upload achieved stable vision, sustained CST reduction, and comparable treatment burden over one year. FAR showed greater fvPED regression and a slight functional trend, while BRZ achieved faster fluid resolution with fewer injections.