Efficacy of Intravitreal Faricimab in Patients with Refractory Macular Edema Secondary to Retinal Vein Occlusion, Diabetic Macular Edema and Neovascular Age-Related Macular Degeneration

Background: This study was designed to assess the anatomical and functional responses after switching to intravitreal faricimab in patients with refractory macular edema secondary to neovascular age-related macular degeneration (n-AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). Methods: Study design: This prospective study enrolled 88 eyes from 76 patients diagnosed with refractory macular edema secondary to RVO, active n-AMD, and DME. Patients treated with three monthly intravitreal injections of faricmab. Patients' demographic data (age and gender) and past medical history for hypertension (HT) and diabetes mellitus (DM) were collected. Best-corrected visual acuity (BCVA) of both eyes, presence or absence of intraretinal fluid (IRF) and subretinal fluid (SRF), and central retinal thickness (CRT) were evaluated using spectral domain optical coherence tomography (SD-OCT) at baseline and at week sixteen. Results: For patients with DME, VA, CRT, IRF, and SRF show a significant improvement (P<0.001). The mean VA reduced from 0.60 (SD±0.24) to 0.44 (SD±0.24) and mean CRT reduced from 464.74 (SD±112.99) to 288.5 (SD±85.04), proportion of eyes with SRF decreased from 15 (32.60%) to 2 (4.34%), while the proportion of eyes with IRF decreased from 46 (100%) to 19 (41.30%),1 month after the third faricimab injection. For RVO patients, VA, CRT, IRF, and SRF show a significant improvement (P<0.05). The mean VA reduced from 0.71 (SD±0.25) to 0.48 (SD±0.27) and mean CRT reduced from 534.3 (SD±144.79) to 324.45 (SD±88.30), proportion of eyes with SRF decreased from 10 (50%) to 2 (10%), and IRF decreased from 20 (100 %) to 9 (45%),1 month after the third faricimab injection. For patients with n-AMD, VA, CRT, IRF, and SRF show a significant improvement (P<0.05). The mean VA reduced from 0.63 (SD±0.18) to 0.39 (SD±0.28) and mean CRT reduced from 411.23 (SD±78.99) to 268.73 (SD±58.13), the proportion of eyes with SRF decreased from 22 (100 %) to 3 (13.63%), and IRF decreased from 6 (27.27%) to 0 (0%), 1 month after the third faricimab injection. Conclusion: In this study, eyes with refractory DME, RVO, and n-AMD showed statistically significant improvements in both morphological and functional characteristics after switching to intravitreal faricimab, showing that faricimab is a promising treatment option, particularly for refractory cases.