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. 2025 Jul;14(7):1481-1489.
doi: 10.1007/s40123-025-01162-7. Epub 2025 May 12.

Real-World Data on Morphological and Functional Responses After Switching to Faricimab in Recalcitrant, Chronic Diabetic Macular Edema

Viktoria Deiters  1 , Anna Lorger  2 , Franziska Eckardt  2 , Jakob Siedlecki  2 , Benedikt Schworm  2 , Siegfried G Priglinger  2 , Tina R Herold  2
Affiliations

Real-World Data on Morphological and Functional Responses After Switching to Faricimab in Recalcitrant, Chronic Diabetic Macular Edema

Viktoria Deiters et al. Ophthalmol Ther. 2025 Jul.

Abstract

Introduction: This study aimed to assess the morphological and functional effects of faricimab in patients with chronic diabetic macular edema (DME) who had an insufficient response to previous treatments.

Methods: We conducted a single-center, retrospective study including eyes with pretreated chronic DME that were switched to faricimab and received at least three injections. The main outcome measures were central subfield thickness (CST) and best-corrected visual acuity (BCVA) changes before and after switching to faricimab.

Results: Twenty-two eyes from 18 patients were analyzed, with a mean pretreatment period of 5.7 years. Most eyes had been treated with two or more intravitreal agents. Before switching to faricimab, the mean CST was 468.5 ± 163.6 µm, which decreased to 383.1 ± 125.3 µm, 362.8 ± 93.4 µm (p = 0.207), and 339.5 ± 94.3 µm (p < 0.001) after the first, second, and third injections, respectively. BCVA showed improvement from 0.48 to 0.37 logMAR after the third injection, though the change was only statistically significant after the first injection (p = 0.022).

Conclusions: The study demonstrated significant CST reduction in patients with chronic DME in a real-world setting, even after prolonged treatment, suggesting that faricimab can lead to morphological and functional benefits in these cases. Further data are needed to explore the real-world, long-term effects and durability of faricimab in chronic DME.

Keywords: Anti-VEGF; Chronic diabetic macular edema; Pretreated.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors declare no competing interests related to this study. However, Tina R. Herold received previous speaker fees from Novartis Pharma GmbH, Bayer Vital GmbH, AbbVie Deutschland GmbH, Novo Nordisk Pharma GmbH, and Roche AG. Jakob Siedlecki received previous speaker fees from Roche AG, Apellis Pharmaceuticals, Novartis Pharma, Carl Zeiss Meditec, Bayer AG, AbbVie, and Heidelberg Engineering. Jakob Siedlecki received personal consultation fees from Roche AG, Bayer AG, Novartis Pharma GmbH, AbbVie, and Apellis Pharmaceuticals. Benedikt Schworm received previous speaker fees and travel expenses from Novartis Pharma GmbH and Topcon Corporation. Siegfried G. Priglinger received previous speaker fees and travel expenses from Novartis Pharma GmbH, Oertli AG, Bayer AG, Alcon Pharm GmbH, and Allergan GmbH. Viktoria Deiters, Franziska Eckardt and Anna Lorger declare no financial disclosures. Ethical Approval: The study adhered to the ethical guidelines of the Declaration of Helsinki, and institutional review board approval was obtained from the Ethics Committee of Ludwig-Maximilians-University Munich (study identifier 24-0638). Due to the retrospective nature of the study, Ethics Committee waived the need for obtaining informed consent.

Figures

Fig. 1
Fig. 1
Changes in central subfield thickness (CST) over time. P-1 = last injection of pretreatment, P-1 FU = next follow-up after P-1, F1 = first injection of faricimab, F2 = second injection of faricimab, F3 = third injection of faricimab, F4 = fourth injection of faricimab, *statistically significant
Fig. 2
Fig. 2
Example of a 74-year-old female patient who had received 24 intravitreal anti-VEGF injections prior to switching to faricimab. (i) Optical coherence tomography (OCT) scan before the switch shows pronounced diabetic macular edema (DME) with intraretinal fluid (IRF) and central photoreceptor layer and retinal pigment epithelium disruption, indicative of advanced retinal damage. (ii) One month after the first faricimab injection, there is a strong morphological response. (iii) Following the second injection, further gradual improvement in retinal morphology is observed, with a continued decrease in IRF. (iv) After the third injection, the OCT shows stable findings with minimal residual edema. Despite the anatomical improvement, visual acuity remains limited due to pre-existing, irreversible central retinal atrophy
Fig. 3
Fig. 3
Example of a 63-year-old male patient who had received 27 intravitreal anti-VEGF injections and intravitreal corticosteroids prior to switching to faricimab. (i) Optical coherence tomography (OCT) scan before the switch reveals a large central intraretinal fluid (IRF) cyst, accompanied by structural disruption in the ellipsoid zone, indicating photoreceptor damage. (ii) Following the first faricimab injection, a partial reduction in the size of the IRF cyst is observed. (iii) After the second injection, continued regression of the IRF is evident. (iv) By the third injection, the IRF cyst has completely resolved, although a persistent loss of the central ellipsoid zone remains visible, suggesting limited potential for full functional recovery
Fig. 4
Fig. 4
Changes in best-corrected visual acuity (BCVA) over time. P-1 = last injection of pretreatment, P-1 FU = next follow-up after P-1, F1 = first injection of faricimab, F2 = second injection of faricimab, F3 = third injection of faricimab, F4 = fourth injection of faricimab, *statistically significant
See this image and copyright information in PMC

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