Improvement After Switching to Dual Inhibition in Refractory Severe DME

In this second case, Dr. Maria Berrocal presents a patient with severe, refractory diabetic macular edema (DME) who had received 13 prior anti-VEGF injections (bevacizumab and aflibercept) with persistent fluid and legal blindness (20/200 vision). Baseline imaging revealed extensive cystoid changes, significant subfoveal detachment, and prominent hard exudates. After switching to faricimab, the patient demonstrated progressive anatomic improvement. Following three injections, edema and subretinal fluid were reduced; after five injections, the subfoveal detachment resolved and exudates diminished. By seven injections, visual acuity improved to 20/80 in the right eye and 20/100 in the left eye.

While visual recovery was limited compared with treatment-naïve patients, the case underscores the importance of early, effective intervention before chronic fluid causes irreversible retinal damage. Roundtable participants emphasized switching quickly when response to anti-VEGF monotherapy is inadequate and highlighted evidence suggesting lower rates of epiretinal membrane formation and improved vascular stabilization with dual VEGF-A/ANG2 inhibition.