Treat-and-Extend Faricimab for Macular Neovascularization in Angioid Streaks: A Report of Two Cases

Introduction: Angioid streaks (AS) are a rare retinal disorder that leads to progressive vision loss, particularly when complicated by macular neovascularization (MNV). Anti-vascular endothelial growth factor agents are the first-line treatment for MNV with AS; however, the optimal treatment strategy remains controversial. Herein, we present two cases of type 2 MNV secondary to AS treated with intravitreal faricimab (IVF), the first bispecific antibody, using a treat-and-extend (T&E) protocol over a 1-year follow-up. Case Presentations: Case 1: A-63-year-old male patient achieved dry macula after three monthly IVF injections, with visual acuity (VA) improving from 20/25 to 20/16. Subretinal fluid recurred 19 weeks after the loading phase, promoting treatment interval adjustment to 16 weeks. Fluid was subsequently controlled with two additional IVF injections with a 16-week interval. Over one year, VA was maintained at 20/16 with five IVF injections. Case 2: A 78-year-old female patient achieved dry macula with four monthly IVF injections, and VA improved from 20/32 to 20/16. The treatment interval was managed despite a recurrence at 16 weeks after the loading phase, leading to seven IVF injections over one year. VA remained stable at 20/16, although pre-existing focal macular atrophy slightly expanded. No subretinal fibrosis or severe ocular complications were observed in both cases. Conclusion: These findings support the efficacy and safety of IVF in the T&E regimen in managing AS-associated type 2 MNV, emphasizing the potential of dual-pathway inhibition for this challenging pathology.