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Abstract

Introduction
Intravitreal faricimab is the first bispecific antibody to target vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2). In the study reported here, we examined the early effect of intravitreal faricimab on hard exudates (HEs) in patients with diabetic macular oedema (DMO).

Methods
Consecutive patients who were initiated on faricimab for centre-involving DMO associated with HEs between August 2022 and July 2023 were reviewed. Areas of HE were confirmed on colour fundus photographs taken at initiation of therapy and at the 6-month follow-up. ImageJ software was used for semi-automated segmentation and measurement of the HE area within the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Demographic data, including age, gender and ethnicity, as well as best-corrected visual acuity (BCVA), central retinal thickness (CRT) and macular volume (MV) were recorded.

Results
A total of 19 eyes from 16 patients were included in the study. Mean age of the cohort was 60.6 (range 49–71) years; ten eyes (53%) were treatment naïve. The median total HE area was reduced from 0.15 (interquartile range [IQR] 0.04–0.30) mm2 to 0.10 (IQR 0.07–0.24) mm2 by the 6-month follow-up. A greater reduction in total HE area was observed in treatment-naïve eyes (− 0.14 mm2) compared with previously treated eyes (+ 0.05 mm2), despite the former having a higher median baseline value (0.25 [IQR 0.15–0.47] mm2 vs 0.05 [IQR 0.04–0.15] mm2). Mean BCVA improved from LogMAR 0.26 ± 0.22 to 0.18 ± 0.19 (p < 0.05), while mean CRT and MV reduced from 413 ± 108 to 340 ± 95 μm (p < 0.001) and from 10.03 ± 1.41 to 9.20 ± 1.17 mm3 (p < 0.0001), respectively.

Conclusion
Intravitreal faricimab may be associated with reduction of HE area in DMO within 6 months of initiation, with greater effects in treatment-naïve eyes. Further studies with longer follow-up are warranted to determine the durability of HE resolution and its comparison to intravitreal steroids and other anti-VEGF agents.

Publication Type:	Article
Additional Information:	© The Author(s) 2026. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Publisher Keywords:	Hard exudates, Faricimab, Diabetic macular oedema
Subjects:	R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Optometry & Visual Science
SWORD Depositor:	Symplectic Administrator

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