Faricimab Effectively Resolves Intraretinal Fluid and Preserves Vision in Refractory, Recalcitrant, and Nonresponsive Neovascular Age-Related Macular Degeneration

Anny M Cheng; Sunir Joshi; Raphael G Banoub; Jackson Saddemi; Kakarla V Chalam

doi:10.7759/cureus.40100

Faricimab Effectively Resolves Intraretinal Fluid and Preserves Vision in Refractory, Recalcitrant, and Nonresponsive Neovascular Age-Related Macular Degeneration

Cureus. 2023 Jun 7;15(6):e40100. doi: 10.7759/cureus.40100. eCollection 2023 Jun.

Authors

Anny M Cheng^{1

2

3}, Sunir Joshi⁴, Raphael G Banoub^{1

2}, Jackson Saddemi^{1

2}, Kakarla V Chalam⁵

Affiliations

¹ Ophthalmology, Broward Health, Fort Lauerdale, USA.
² Ophthalmology, Specialty Retina Center, Coral Springs, USA.
³ Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
⁴ Ophthalmology, South Florida Vision, Fort Lauerdale, USA.
⁵ Ophthalmology, Loma Linda University School of Medicine, Loma Linda, USA.

Abstract

Purpose: To evaluate the functional and anatomic outcomes of faricimab treatment in patients with neovascular age-related macular degeneration (nAMD) who are unresponsive to other anti-vascular endothelial growth factor (VEGF) therapies.

Methods: A retrospective interventional study was conducted on patients with refractory nAMD who were initially treated with intravitreal bevacizumab, ranibizumab, or aflibercept. These patients were switched to monthly faricimab injections. The central subfield thickness (CST), intraretinal fluid (IRF) or subretinal fluid (SRF) height, and visual acuities were compared before and after faricimab treatment.

Results: A total of 13 eyes (eight right eyes and five left eyes) from 11 patients were followed for 10.4 ± 6.9 months after bevacizumab treatment and 40.3 ± 28.7 months after aflibercept treatment before switching to faricimab. The follow-up time for patients receiving a mean number of 3.7 ± 1.3 faricimab injections was 3.4 ± 1.2 months. The overall median CST was reduced by 18µm (p=0.001) from 342µm to 318µm, along with a reduction of 89µm (p=0.03) in IRF/SRF height from 97µm to 40µm. Following three consecutive injections, the CST showed a significant reduction of 21.5µm (p=0.004) from 344µm to 322.5µm, and IRF/SRF height was reduced by 89µm (p=0.03) from 104µm to 18.5µm. The intraretinal fluid size decreased and leakage stopped, as seen on fluorescein angiography. Visual acuity remained stable after switching to faricimab treatment (0.59 ± 0.45 logMAR vs 0.58 ± 0.45 logMAR, p=1).

Conclusions: Faricimab has proven to be an effective treatment for nAMD patients resistant to other anti-VEGF agents. It demonstrates significant anatomical improvement and vision preservation in this challenging patient population.

Keywords: central subfield thickness; faricimab; intraretinal fluid; intravitreal anti-vascular endothelial growth factor; refractory namd; subretinal fluid; vabysmo.