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Epivascular Glia and Macular Pigment Changes after Faricimab or Aflibercept during the Loading Phase in Diabetic
Gilda Cennamo1, Michele Rinaldi1, Erica Caporale1
1Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples 80131, Italy.
Purpose:
To explore short-term changes in epivascular glia (EVG), macular pigment optical density (MPOD), visual acuity, and retinal thickness after faricimab or aflibercept in treatment-naive eyes with center-involving diabetic macular edema (DME).
Methods:
This prospective, non-randomized pilot study included 30 eyes with DME and EVG on en face optical coherence tomography. Fifteen eyes received three monthly injections of faricimab 6 mg and 15 received aflibercept 2 mg. The primary exploratory outcome was complete EVG regression after loading. Secondary outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), MPOD, fluid resolution, and resolution of traction-related abnormalities.
Results:
Complete EVG regression occurred in 12/15 eyes (80.0%) with faricimab and 6/15 (40.0%) with aflibercept (Fisher's exact p=0.060). Resolution of traction- related abnormalities occurred in 11/15 (73.3%) and 5/15 eyes (33.3%), respectively (p=0.066). Post-loading CMT was 274.5 ± 61.3 versus 328.7 ± 72.4 µm (unadjusted p=0.035), MPOD was 0.46 ± 0.07 versus 0.39 ± 0.08 (unadjusted p=0.017), and BCVA was 0.27 ± 0.14 versus 0.36 ± 0.16 logMAR (p=0.112).
Conclusions:
EVG and traction- related outcomes were numerically more favorable with faricimab but were not statistically significant. Exploratory anatomical and MPOD differences require confirmation in larger randomized studies.
