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Research Article: Early clinical outcomes after switching to faricimab in previously treated diabetic macular edema

Date Published: 2026-09-30

Abstract:
To evaluate short-term functional, anatomical, morphologic, and optical coherence tomography angiography (OCTA)-derived outcomes after switching to intravitreal faricimab in previously treated diabetic macular edema (DME) with persistent or recurrent center-involving retinal fluid after conventional anti-vascular endothelial growth factor therapy without angiopoietin-2 inhibition. This single-center retrospective study included 50 eyes from 50 patients with previously treated DME and center-involving intraretinal and/or subretinal fluid at the time of switching. All eyes received four consecutive monthly intravitreal faricimab injections. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed through Month 4. OCT morphologic features were evaluated at baseline and Month 4, and OCTA-derived foveal avascular zone (FAZ) area, superficial capillary plexus vessel density (SCP-VD), and deep capillary plexus vessel density (DCP-VD) were evaluated at baseline, Month 1, and Month 4. Mean CMT decreased from 526.8?±?55.8 ?m at baseline to 255.6?±?20.5 ?m at Month 4, while mean BCVA improved from 0.80?±?0.19 to 0.28?±?0.10 logMAR (both P <?0.001), with consistent linear mixed-effects model results. SRF resolved in all 11 eyes with baseline SRF. IRF resolved in 38 of 50 eyes (76.0%) and decreased in the remaining 12 eyes. HRF resolved in 4 of 10 eyes (40.0%) and decreased in the remaining 6 eyes. FAZ area, SCP-VD, and DCP-VD showed no significant longitudinal change. Baseline FAZ area showed weak inverse correlations with CMT reduction and BCVA improvement, but these associations did not remain significant after Bonferroni correction. Baseline SCP-VD and DCP-VD were not significantly associated with treatment response. No serious ocular or systemic adverse events were observed. Faricimab switching followed by four consecutive monthly injections was associated with substantial short-term anatomical and visual improvement in previously treated DME with persistent or recurrent center-involving retinal fluid. Early clinical improvement occurred without parallel changes in global OCTA-derived perfusion parameters. Larger prospective controlled studies are needed to clarify the treatment-specific contribution and durability of faricimab switching.

Introduction:
Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetic retinopathy (DR). Its pathogenesis involves chronic hyperglycemia-related inflammation, vascular dysfunction, and breakdown of the blood–retinal barrier (BRB), leading to increased vascular permeability and accumulation of intraretinal and/or subretinal fluid in the macula ( 1 ). Intravitreal inhibition of vascular endothelial growth factor (VEGF) is the current first-line treatment for center-involving DME and can…

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