Characteristics of Microaneurysm Size in Residual Edema After Intravitreal Injection of Faricimab for Diabetic...

Area of Science:

• Ophthalmology
• Medical Imaging
• Pharmacology

Background:

• Diabetic macular edema (DME) is a significant complication of diabetes.
• Microaneurysms (MAs) are key pathological features in DME.
• Understanding MA behavior is vital for assessing treatment efficacy, particularly with anti-VEGF therapies.

Purpose of the Study:

• To investigate the morphological characteristics of microaneurysms (MAs) in persistent diabetic macular edema (DME) after faricimab treatment.
• To compare MA turnover, formation, and disappearance in residual versus resolved edema areas.
• To identify specific MA features associated with resistance to faricimab therapy.

Main Methods:

• Patients with DME receiving three monthly faricimab injections and exhibiting residual edema were selected.
• Microaneurysm (MA) turnover (loss and new formation) was quantified in both residual and absorbed edema areas.
• MA counts were determined using merged optical coherence tomography (OCT) and fluorescein angiography images.

Main Results:

• Residual edema was observed in 8 of 42 patients after three faricimab injections.
• Residual edema areas showed significantly higher MA density and maintained MAs (p=0.04).
• Lower MA disappearance (p=0.04) and turnover (p=0.01) were noted in residual edema.
• Persisting MAs in residual edema were predominantly large-sized (p=0.01) compared to absorbed areas.

Conclusions:

• Faricimab treatment resulted in higher MA density and less MA loss in residual edema areas.
• A high density of large-sized MAs in residual edema is characteristic of DME cases resistant to faricimab.
• These findings highlight the role of specific MA morphologies in predicting treatment outcomes for DME.