EFFECTS OF FARICIMAB LOADING PHASE ON DIABETIC MACULAR EDEMA IN REAL-WORLD SETTING: An Optical Coherence Tomography...

To explore the functional and anatomic outcomes of eyes with resistant diabetic macular edema undergoing a loading phase of four intravitreal faricimab.

Prospective research on 46 eyes with diabetic macular edema previously treated with aflibercept or ranibizumab. At baseline (V0) and each monthly follow-up examination (V1-V4), we evaluated best-corrected visual acuity, optical coherence tomography, and angiography. Biomarkers such as central macular thickness, integrity of the ellipsoid zone/external limiting membrane, hyperreflective foci, disorganization of inner retina layers, and presence/absence of epiretinal membrane and subretinal fluid were collected, along with the vessel density (VD) in the superficial capillary plexi and deep capillary plexi and the foveal avascular zone area.

Best-corrected visual acuity significantly improved from baseline to V4 (0.55 ± 0.42 vs. 0.36 ± 0.30 logMAR; P = 0.03). Sixty-five percent of eyes showed visual improvement during follow-up, whereas 91% showed anatomic improvement, with a mean central macular thickness reduction of 108.4 µm (P = 0.0002). At V0, 20 eyes (43%) had irregularities of the external limiting membrane/ellipsoid zone complex compared with 14 eyes (30%) at V4 (P = 0.28). Hyperreflective focis were visible in 87% of cases at baseline but reduced their prevalence up to 24 eyes (52%) at V4 (P = 0.0005). Disorganization of inner retina layers was reported in eight eyes (17%) at baseline and resolved in three eyes. Foveal avascular zone area was stable during follow-up, as well as superficial capillary plexi's VD, whereas the parafoveal deep capillary plexi's VD significantly increased from V0 to V4 (P = 0.04).

Faricimab loading phase showed promising results in visual outcomes and structural improvement in resistant diabetic macular edema.