Real-World Outcomes of Faricimab Versus Aflibercept in Treatment-Naïve Neovascular Age-Related Macular Degeneration with Pigment Epithelial Detachment

Purpose To compare the real-world early outcomes of faricimab versus aflibercept 2 mg in Asian patients with treatment-naïve neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV), focusing on retinal pigment epithelial detachment (RPED) reduction.Methods This retrospective study included treatment-naïve nAMD or PCV eyes with baseline RPED receiving three consecutive monthly loading injections of aflibercept or faricimab. Best-corrected visual acuity, central macular thickness (CMT), intraretinal or subretinal fluid, maximum RPED height, and RPED improvement ratio were assessed at baseline and after treatment. RPED was classified as fibrovascular or serous/mixed by optical coherence tomography.Results Fifty-eight eyes were included: 27 treated with faricimab and 31 with aflibercept. Both aflibercept and faricimab had significantly reduced CMT (−99.7 ± 101.2 and −129.6 ± 109.3 μm; both p < .001) and maximum RPED height (−99.4 ± 205.6 and −151.4 ± 183.5 μm; p = .011 and <0.001, respectively). In the fibrovascular RPED subgroup, the RPED improvement ratio was significantly greater with faricimab (35.6% vs. 16.5%; p = .029). Serous component resolution was also more frequent with faricimab (100% vs 61.5%; p = .045).Conclusions Both treatments improved retinal anatomy, while faricimab produced greater fibrovascular RPED height reduction and more complete serous component resolution.