Biological Changes in Fibrovascular Membranes of Patients With Proliferative Diabetic Retinopathy Following Faricimab Injection

Overview

DR is a common microvascular complication of DM that significantly impacts vision. Approximately one-third of DM patients develop DR, with 10% progressing to PDR. PDR is characterized by retinal ischemia-induced VEGF overexpression and pathological NV. NV proliferates along the vitreoretinal interface, potentially forming FVMs that increase RD risk and may lead to TRD. FVM formation directly affects PPV complexity. Preoperative anti-VEGF injection reduces intraoperative bleeding and eliminates NV, but may accelerate fibrosis. Previous studies mainly focused on angiogenic/profibrotic factor changes in AH/VH, but whether FVM changes mirror these remains unclear. This study compared mRNA levels of relevant factors in FVMs from PDR patients treated with faricimab versus conbercept, and investigated their effects on angiogenesis and fibrosis progression in FVMs.

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes that significantly affects the visual health of patients. The incidence of DR is increasing annually worldwide, with approximately one-third of patients with diabetes developing DR and approximately 10% progressing to proliferative diabetic retinopathy (PDR), which is an advanced stage of DR characterised primarily by retinal ischaemia that leads to the overexpression of vascular endothelial growth factor (VEGF) and the formation of abnormal neovascularization. These new blood vessels proliferate along the vitreoretinal interface, potentially resulting in the formation of fibrovascular membranes (FVM). The presence of FVM not only increases the risk of retinal detachment but may also lead to severe complications such as tractional retinal detachment (TRD). The formation and characteristics of FVMs directly influence the complexity of pars plana vitrectomy (PPV). Preoperative injection of anti-vascular endothelial growth factor (anti-VEGF) agents is an effective strategy to reduce intraoperative bleeding and eliminate neovascularization (NV). However, per previous studies, anti-VEGF therapy may accelerate the progression of fibrosis. Changes in profibrotic factors in FVM have garnered significant interest. Previous studies have mainly focused on the changes in angiogenic and profibrotic factors in the aqueous humor or vitreous humor. However, whether the changes in these factors in the FVM are consistent with those in the vitreous and aqueous humors remains a question worth exploring. In this study, researchers compared the mRNA levels of relevant factors in the FVMs of patients with PDR treated with faricimab or conbercept. Additionally, we investigated the effects of different anti-VEGF agents on the progression of angiogenesis and fibrosis in the FVMs of patients with PDR.