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Asako Tanaka, Masayuki Hata, Memiri Tsuchikawa, Naoko Ueda-Arakawa Ueda-Arakawa, Hiroshi Tamura, Manabu Miyata, Ayako Takahashi, Ai Kido, Yuki Muraoka, Masahiro Miyake, Sotaro Ooto, Akitaka Tsujikawa Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanCorrespondence: Masayuki Hata, Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan, Tel +81-75-751-3248, Fax +81-75-752-0933, Email trj74h6@kuhp.kyoto-u.ac.jpPurpose: To evaluate the efficacy and safety of faricimab injections for treatment-naïve neovascular age-related macular degeneration (nvAMD) patients, including subtypes and pachychoroid phenotypes, and identify predictive factors for visual outcomes.Methods: nvAMD patients were prospectively recruited, receiving three monthly faricimab (6 mg) injections. Best-corrected visual acuity (BCVA) two months after the last injection (month 4) was compared between subtypes, and between pachychoroid neovasculopathy (PNV) and non-PNV eyes. Regression analysis determined factors influencing month 4 BCVA.Results: The study involved 23 patients (12 typical AMD [tAMD], 10 polypoidal choroidal vasculopathy [PCV], 1 retinal angiomatous proliferation [RAP]). Eleven exhibited PNV phenotype. Significant BCVA (P = 4.9 × 10− 4) and central retinal thickness (CRT) (P = 1.3 × 10− 5) improvements were observed post-faricimab treatment. The therapy demonstrated favourable results for both tAMD and PCV eyes, and non-PNV and PNV eyes. Faricimab achieved dry macula in 77.3% of eyes, with subretinal fluid resolution in most cases, although intraretinal fluid (IRF) often persisted. Multivariable analysis identified external limiting membrane (ELM) presence and IRF as BCVA contributors at month 4.Conclusion: Faricimab demonstrated significant effectiveness and safety in treatment-naïve nvAMD patients, particularly for PCV and PNV eyes. ELM presence and IRF is predictive of visual outcomes.Keywords: anti-VEGF, anti-vascular endothelial growth factor, CRT, central retinal thickness, ELM, external limiting membrane, faricimab, IRF, intraretinal fluid, MNV, macular neovascularization, nvAMD, neovascular age-related macular degeneration, PCV, polypoidal choroidal vasculopathy, PNV, pachychoroid neovasculopathy, RAP, retinal angiomatous proliferation