Two-Year Real-World Outcomes of Faricimab in Treatment-Resistant Neovascular Age-Related Macular Degeneration

Objective: To evaluate long-term visual and anatomical outcomes of faricimab (Vabysmo ® ) in patients with neovascular age-related macular degeneration (nAMD) showing suboptimal response to aflibercept 2mg (Eylea ® ) in a real-world setting. Methods: This retrospective cohort study evaluated 152 eyes from 126 patients switched to faricimab. All received four loading doses, then a treat-and-extend regimen with ≥ 20-month follow-up. Primary outcomes were changes in non-refracted best-recorded visual acuity (BRVA) and central subfield thickness (CST). Secondary outcomes: fluid status, treatment interval, and safety. Results: Baseline mean BRVA was 69.91 ± 13 letters, maintained at year 2 (65.9 ± 17.1, p = 0.622). CST decreased from 301.5 ± 86.9 μm at baseline to 222.2 ± 49.2 μm at year 2 (p < 0.001). Complete fluid resolution rose from 12.5% at baseline to 50.7% and 49.3% in years 1 and 2 respectively. Subretinal fluid decreased from 79% to 34% (p < 0.001), while intraretinal fluid improved post-loading (30% to 18%, p=0.005) but remained detectable in 25.7% by year 2 (p=0.36). Treatment intervals were extended from 5.8 ± 1.4 weeks to 9.7 ± 3.1 weeks at year 2 (p < 0.001). By year 2, 18% of eyes achieved ≥ 12-week intervals; 7% achieved ≥ 16-week intervals. No cases of endophthalmitis, vasculitis, or retinal artery occlusion were observed, and ocular adverse events occurred in 3% of eyes. Conclusion: In treatment-resistant nAMD, switching from aflibercept 2mg to faricimab maintained vision, improved anatomical outcomes, enabled extended treatment intervals, and showed a favorable safety profile over 2 years.