Abstract

Macular edema secondary to retinal vein occlusion (RVO) remains a major cause of visual impairment, and some patients show incomplete response despite repeated anti-vascular endothelial growth factor (VEGF) therapy. Faricimab, through dual inhibition of VEGF-A and angiopoietin-2, may provide an alternative option for refractory cases. Systematic searches of PubMed, Scopus, and Embase were conducted from inception to May 2026. Eligible studies assessed faricimab switching in anti-VEGF-refractory RVO-related macular edema. Seven studies underwent qualitative synthesis, and six independent cohorts were meta-analyzed using random-effects models. Heterogeneity for primary outcomes was assessed using I² statistics and heterogeneity p-values. Seven studies were included qualitatively, while six independent cohorts were included in the main quantitative synthesis after excluding a potentially overlapping Hafner cohort, comprising 183 patients and 184 eyes. Switching to faricimab was associated with a significant reduction in retinal thickness, with a pooled mean change of −120.266 µm. Best-corrected visual acuity also improved significantly, with a pooled mean change of −0.116 logMAR. Complete fluid resolution was achieved in 57.1% of eyes, while post-treatment intraretinal fluid persisted in 38.3% of eyes. Switching to faricimab might provide meaningful anatomical and functional benefits in patients with anti-VEGF-refractory RVO-related macular edema. Although the findings are encouraging, the evidence was mainly based on small real-world studies with short follow-up. Larger prospective trials are required to confirm long-term efficacy, safety, and optimal switching strategies.

Key words: Faricimab, retinal vein occlusion, macular edema, anti-VEGF, refractory disease, intraretinal fluid, systematic review, meta-analysis