Short-Term Anatomical and Functional Outcomes After Switching to Faricimab in Therapy-Resistant Retinal Vein Occlusion–Related Macular Edema: A Real-World Study

Abstract Background This study evaluated the real-world anatomical and functional outcomes of faricimab in patients with macular edema secondary to retinal vein occlusion (RVO) who showed insufficient response to prior intravitreal therapies. Methods This retrospective, observational single-center study included consecutive patients with macular edema secondary to branch (BRVO) or central retinal vein occlusion (CRVO) who were switched to faricimab after inadequate response to prior intravitreal therapy, from January 2024 to October 2025. Persistent macular edema was defined as refractory intraretinal and/or subretinal fluid on optical coherence tomography (OCT) and/or lack of functional improvement despite previous intravitreal treatment with at least five intravitreal injections of anti-vascular endothelial growth factor (VEGF), and/or dexamethasone implant. Eligible eyes received at least three faricimab injections after the switch and had at least three months of follow-up. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were assessed before and after switching. Secondary outcomes included macular volume analysis and change in treatment intervals. Results Twenty-six eyes (25 patients; mean age ± SD 70.8 ± 10.7 years) were included; 53.8% (n = 14) BRVO and 46.2% (n = 12) CRVO. All eyes had received extensive prior intravitreal treatment: 16.6 ± 15.5 (20 eyes, 76.9%) mean previous ranibizumab injections; 33.0 ± 31.4 (23 eyes, 88.5%) mean previous aflibercept 2 mg injections; 3 eyes (11.5%) received at least 1 prior dexamethasone implant. Overall, the cumulative anti-VEGF burden before switching was 42.0 ± 37.6 injections per eye. After the first faricimab injection, mean CST decreased significantly from 307.4 ± 80.0 µm to 269.5 ± 48.2 µm (Δ − 37.9 µm, mean paired change − 35.5 µm, p = 0.001). Mean macular volume also showed a reduction, most notably in the 6‑mm foveal-centered ETDRS area (p = 0.019). BCVA remained stable, with a non-significant trend toward improvement (p = 0.063). Treatment intervals were maintained compared with pre-switch regimens (p = 0.572). After 3 injections, anatomical benefits were maintained, with persistent CST reduction (p = 0.034). No serious ocular or systemic adverse events were observed. Conclusion In this real-world cohort of therapy-resistant RVO-related macular edema, switching to faricimab produced rapid anatomical improvement while maintaining visual acuity and treatment intervals, supporting its use as an effective, well-tolerated switch therapy in difficult-to-treat RVO.