Changes in retinal venous diameter in proliferative diabetic retinopathy patients with diabetic macular edema following faricimab treatment: an observational study.

INTRODUCTION

To evaluate the effect of intravitreal faricimab injections on retinal venous diameter in proliferative diabetic retinopathy (PDR) patients with diabetic macular edema (DME).

METHODS

This single-center, retrospective cohort study included 46 PDR patients (46 eyes) with DME, treated between August 2024 and January 2025. All participants received intravitreal faricimab combined with panretinal photocoagulation (PRP). Best-corrected visual acuity (BCVA, logMAR), central foveal thickness (CFT, μm), microaneurysm (MA) count, hard exudates (HE), neovascularization (NV) area, and retinal venous diameter were assessed at baseline and at 1, 3, and 6 months post-treatment.

RESULTS

Significant improvements in BCVA were observed at 1, 3, and 6 months (0.52 ± 0.16, 0.48 ± 0.18, 0.40 ± 0.15 vs. baseline 0.66 ± 0.18; all P < 0.05). CFT showed a significant reduction at all time points (381.35 ± 40.75, 327.30 ± 43.40, 297.56 ± 35.81 μm vs. baseline 472.34 ± 47.23 μm; all P < 0.05). The MA count showed no significant reduction at 1 month (P > 0.05) but decreased significantly thereafter (72.71 ± 20.53 and 63.06 ± 17.08 at 3 and 6 months, respectively; both P < 0.05). Reductions in HE area were not significant at 1 or 3 months (in 2 and 6 patients, respectively; both P > 0.05). At 6 months, a significant reduction in HE area was observed in 14 patients (P < 0.05). The NV area was significantly reduced at 1, 3, and 6 months compared to baseline (0.17 ± 0.10 mm², 0.17 ± 0.09 mm², and 0.17 ± 0.08 mm² vs. 0.98 ± 0.17 mm²; all P<0.05). Retinal venous diameter showed no significant change at 1 and 3 months compared with baseline (both P > 0.05) but was significantly reduced at 6 months (299.40 ± 19.56 μm; P < 0.05).

CONCLUSION

Intravitreal faricimab was safe and effective for PDR patients with DME. A trend toward morphological reversal of retinal venous diameter was demonstrated at 6 months, suggesting that faricimab may influence retinal microvascular remodeling through dual inhibition of the VEGF-A and Ang-2 pathways.