Rapid Resolution of Steroid-Refractory DME With Dual Inhibition

In this third case, Dr. Maria Berrocal describes a patient with highly cystic diabetic macular edema (DME) in the left eye who had shown minimal response to two prior steroid injections. Despite expectations that inflammatory-driven edema might improve with corticosteroids, the patient experienced no meaningful anatomical resolution. After a single injection of faricimab, however, the edema essentially resolved, and visual acuity improved to 20/50. Following a second injection at eight weeks, the patient maintained stable vision and remained dry at 12 weeks, allowing for rapid interval extension.

This case highlights the potential for dual VEGF/ANG2 inhibition to achieve robust drying even in eyes that appear steroid-refractory. Roundtable participants noted a broader shift away from routine steroid use, favoring therapies that provide similar anti-inflammatory and vascular-stabilizing effects with improved durability. The overarching treatment goal emphasized was early use of the most effective agent to maximize drying, reduce long-term retinal damage, and minimize patient burden to three or four injections annually.