Choroidal Vascular Remodeling After Loading Injections of Faricimab in Diabetic Macular Edema

We evaluated choroidal structural changes in patients with diabetic macular edema (DME) after a loading phase of 3 monthly intravitreal faricimab injections.

This retrospective cohort study included treatment-naïve patients with newly diagnosed DME who received 3 monthly intravitreal injections of faricimab. Researchers analyzed data from patients with available follow-up at 1 month after the third injection. Assessments included best-corrected visual acuity, central retinal thickness (CRT), and subfoveal choroidal thickness (SFCT). Hyper-reflective choroidal foci, and the choroidal vascularity index (CVI) of Sattler's and Haller's layers were assessed using enhanced depth imaging optical coherence tomography within a 1.5-mm zone.

A total of 24 eyes from 24 treatment-naïve patients were included. After the loading phase, best-corrected visual acuity improved significantly, and both CRT and SFCT decreased markedly. The number of hyper-reflective choroidal foci remained unchanged, and the CVI of Haller's layer increased significantly. No ocular or systemic adverse events occurred during the study period.

Loading-phase treatment with faricimab produced functional and anatomical improvements in the retina and choroid of patients with DME. These findings suggest that faricimab may contribute to choroidal vascular remodeling in addition to resolving retinal fluid.

This study shows that observed associations in imaging biomarkers after faricimab loading, such as SFCT and CVI, may provide additional clinical insights for individualized patient assessment in real-world settings, supporting the use of choroidal imaging as a complementary tool for managing diabetic macular edema.