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Background and Importance Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in older adults. Despite anti-VEGF therapies, some patients remain refractory, requiring frequent injections and showing persistent retinal fluid. Faricimab, a bispecific antibody targeting VEGF-A and Ang-2, shows promise in extending treatment intervals and improving anatomical outcomes. However, real-world data in heavily pretreated populations remain limited.Aim and Objectives To evaluate whether treatment with faricimab in heavily pretreated nAMD patients enables extended dosing intervals (Q) and improves retinal anatomy, defined as the absence of intraretinal fluid (IRF) and subretinal fluid (SRF), at week 40.Material and Methods Retrospective, observational, single-centre study including patients initiating faricimab between 30/10/2023 and 28/02/2025, with 40 weeks of follow-up. All patients were refractory to ≥2 lines of anti-VEGF therapy per institutional criteria. A treat-and-extend regimen was applied, adjusting dosing intervals (Q, in weeks) based on disease activity. IRF and SRF were assessed via optical coherence tomography (OCT) as binary variables (presence/absence). Data were extracted from electronic medical records and analysed using Excel.Results 46 patients (47 eyes) were included; 38 completed follow-up. Mean prior treatment lines: 2.13 ± 0.43; median prior injections: 29 (range 5–152). Baseline mean Q: 4.59 ± 1.23 weeks; at 40 weeks: 7.75 ± 2.85 weeks.Q was extended in 76.32%, maintained in 15.79%, and shortened in 7.89%. At baseline 95.65% had intraretinal and/or subretinal fluid: 21.74% had both IRF and SRF, 23.91% IRF only, 50% SRF only, and 4.35% no fluid. At week 40, 55.26% showed no fluid; among them, 95.24% had Q extended. Of those with persistent fluid, 52.94% also achieved Q extension.Subgroup analysis: Baseline At week 40 Fluid Type Patients (n) Fluid Resolution Q extension in partial responders IRF + SRF 8 3 (37.5%) 3 of 5 (60%) IRF only 9 6 (66.66%) 2 of 3 (66.66%) SRF only 19 11 (57.89%) 2 of 8 (25%) Conclusion and Relevance Faricimab enabled dosing interval extension and improved retinal anatomy in a majority of heavily pretreated nAMD patients. These findings support its use in clinical practice. Further controlled studies with larger sample sizes are warranted to confirm these outcomes.Conflict of Interest No conflict of interest