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

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 μm at baseline to 255.6 ± 20.5 μm 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.