Switching to faricimab in anti-VEGF-refractory retinal vein occlusion: nine-month prospective real-world outcomes under a modified treat-and-extend regimen

Abstract Purpose To evaluate nine-month outcomes after switching to faricimab in anti-VEGF-refractory retinal vein occlusion (RVO) under a modified treat-and-extend (T&E) regimen. Methods In this prospective real-world study, 34 eyes of 34 patients with macular edema (ME) secondary to RVO were switched to faricimab. Eligibility required persistent center-involving intraretinal fluid (IRF) across the three most recent treatment visits, central subfield thickness (CST) ≥ 270 μm at switching, and ≥ 3 prior anti-VEGF injections with the three most recent intervals of 4–6 weeks and no ability to extend beyond six weeks. Treatment followed a modified T&E regimen with a single loading dose. Best-corrected visual acuity (BCVA), CST, OCT biomarkers, and treatment intervals were evaluated through the fifth injection visit. Baseline-to-final comparisons were supplemented by longitudinal mixed-effects analyses. Results Median BCVA improved from 0.2 to 0.1 logMAR ( p = 0.04), and median CST decreased from 298 to 270 μm ( p = 0.003). IRF decreased from 100% to 47% ( p < 0.001) and hyperreflective foci from 53% to 21% ( p = 0.003). Mean treatment intervals increased from 4.7 ± 0.9 to 9.5 ± 3.0 weeks ( p < 0.001), with extension possible in 94% of eyes. Both central and branch RVO subgroups showed significant interval extension. No intraocular inflammation or other serious ocular adverse events occurred. Conclusions Switching to faricimab was associated with sustained anatomical improvement, modest functional benefit, and clinically meaningful interval extension. These findings support a response-guided modified T&E switch strategy without a conventional loading phase in treatment-intensive RVO. Clinical trial registration German Clinical Trials Register (DRKS): DRKS00036984.