Functional Real-World Outcomes of Aflibercept 8 mg Versus Faricimab After Loading Phase in Diabetic Macular Edema

Introduction: Aflibercept 8 mg and faricimab provide effective anatomical and visual acuity improvements in diabetic macular edema (DME), although functional recovery may not be fully captured by conventional endpoints. Microperimetry offers a sensitive and spatially resolved assessment of macular function and may better reflect early neurosensory changes. Methods: This real-world, retrospective comparative cohort study included 60 treatment-naïve eyes of 60 patients with center-involving DME treated at Ospedale Fiorini di Terracina. Thirty eyes received intravitreal aflibercept 8 mg and 30 eyes received intravitreal faricimab 6 mg as three consecutive monthly injections. Outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT) measured by spectral-domain optical coherence tomography, and mean retinal sensitivity (RS) assessed using Nidek MP-3 microperimetry. Statistical analyses included paired and unpaired t tests, repeated-measures analysis of variance, odds ratios (OR) for achieving a ≥ 3 dB RS gain, and Pearson correlation analyses. Results: Both treatments significantly improved BCVA and CRT after the loading phase, with slightly greater improvements observed in the faricimab group, although not statistically significant. Mean CRT reduction was − 122 ± 47 µm with aflibercept 8 mg and − 138 ± 52 µm with faricimab (p = 0.21). BCVA improved by + 5.8 ± 4.9 and + 7.2 ± 5.4 letters, respectively (p = 0.17). Retinal sensitivity increased in both groups, with a greater gain observed with faricimab (+ 4.8 ± 1.9 dB) compared with aflibercept (+ 2.1 ± 1.6 dB; p < 0.001). Faricimab-treated eyes were more likely to achieve a ≥ 3 dB RS improvement (OR 3.2; 95% CI 1.4–7.6). RS improvement correlated with CRT reduction (r = 0.42) and BCVA gain (r = 0.57). Conclusion: Despite similar anatomical and visual acuity outcomes, faricimab was associated with greater short-term improvement in retinal sensitivity compared with aflibercept 8 mg during the loading phase. These findings support microperimetry as a sensitive functional endpoint in DME research and selected clinical settings.