Loading-phase treatment with faricimab produced functional and anatomical improvements in the retina and choroid of patients with DME, suggesting that faricimab may contribute to choroidal vascular remodeling in addition to resolving retinal fluid.
Best-corrected visual acuity improved significantly after a loading phase of 3 monthly intravitreal faricimab injections in treatment-naïve DME patients.
Central retinal thickness (CRT) decreased markedly after the faricimab loading phase.
Subfoveal choroidal thickness (SFCT) decreased markedly after the faricimab loading phase.
The choroidal vascularity index (CVI) of Haller's layer increased significantly after the faricimab loading phase.
The number of hyper-reflective choroidal foci remained unchanged after the faricimab loading phase.
No ocular or systemic adverse events occurred during the study period.
Choroidal imaging parameters such as SFCT and CVI may provide additional clinical insights for individualized patient assessment in DME management.
This research suggests that faricimab, a dual-action eye injection drug used to treat diabetic macular edema (DME), not only improves vision and reduces swelling in the retina but also causes structural changes in the choroid — the layer of blood vessels beneath the retina. In a study of 24 patients who had never previously been treated for DME, three monthly injections of faricimab led to significant improvements in visual acuity, notable reductions in retinal swelling (central retinal thickness), and thinning of the choroidal layer (subfoveal choroidal thickness). Importantly, the proportion of large blood vessels in the deepest choroidal layer (Haller's layer), measured by the choroidal vascularity index, increased significantly, suggesting the choroid's vascular structure was being remodeled. Meanwhile, a different marker called hyper-reflective choroidal foci did not change, indicating that not all choroidal features respond equally to this treatment. This research suggests that faricimab's effects extend beyond the retina itself, potentially reshaping blood vessel architecture in deeper ocular layers. This is notable because faricimab targets two molecular pathways (VEGF-A and Ang-2) known to influence blood vessel stability and growth, which may explain why it appears to affect choroidal structure in ways that single-target treatments might not. The absence of any adverse events during the study period also supports its safety profile over the loading phase. Practically, this research suggests that measuring choroidal thickness and the choroidal vascularity index using specialized imaging (enhanced depth imaging OCT) could serve as useful additional tools for doctors monitoring how individual patients respond to faricimab treatment. Rather than relying solely on retinal swelling measurements, clinicians may gain further insight into treatment response by also examining choroidal structural changes — potentially helping to personalize DME management strategies in real-world clinical practice.
Kim J, Han Y, Kim Y, Lee J. (2026). Choroidal Vascular Remodeling After Loading Injections of Faricimab in Diabetic Macular Edema.. Translational vision science & technology. https://doi.org/10.1167/tvst.15.9.8