Early macular choroidal hemodynamic changes after faricimab loading in treatment-naïve diabetic macular edema

To investigate the early macular choroidal hemodynamic changes induced by faricimab loading in treatment-naïve diabetic macular edema (DME) and to determine potential systemic crossover effects by comparing faricimab-injected eyes with the contralateral non-injected eyes.

This retrospective, single-center cohort study analyzed data of a total of 92 eyes from 46 treatment-naïve patients with DME. All patients received three consecutive monthly intravitreal faricimab injections in the study eye. The primary outcome was the longitudinal change in macular choroidal blood flow (CBF) in injected and contralateral non-injected eyes, together with changes in central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT). Macular CBF was quantified as mean blur rate (MBR) using laser speckle flowgraphy. Data were analyzed using a linear mixed-effects model.

In the 46 injected eyes, faricimab treatment resulted in significant monthly decreases in CRT and SFCT. This anatomical improvement was accompanied by a modest but statistically significant reduction in macular CBF, whereas ocular perfusion pressure remained stable. Visual acuity significantly improved. In contrast, no significant changes occurred in macular CBF, CRT, or SFCT in the 46 contralateral non-injected eyes.

Initial faricimab loading therapy yielded marked anatomical improvements with only modest changes in macular choroidal perfusion in treatment-naïve DME. No measurable changes were detected in the contralateral non-injected eyes, suggesting that the early effects of faricimab are predominantly localized to the treated eye.