Bilateral hemorrhagic occlusive retinal vasculitis and panuveitis following intravitreal faricimab injection: A clinicopathologic case study

Purpose: To describe the clinicopathological study of severe bilateral intraocular inflammation following intravitreal (IVT) injection of faricimab in a patient with neovascular age-related macular degeneration (nAMD). Observation: An 80-year-old Caucasian female with bilateral nAMD presented with blurry vision and ocular pain after receiving bilateral IVT injections of faricimab on separate days from different lots. The patient experienced significant reduction in her visual acuity, from 20/40 to counting-fingers in the right eye and from 20/50 to hand-motion in the left eye; intraocular pressure (IOP) was elevated in both eyes at 48 mmHg and 49 mmHg. Anterior segment examination revealed bilateral diffuse mutton-fat keratic precipitates and fundus examination revealed bilateral vitreous opacities. Fluorescein angiography demonstrated optic disc leakage and bilateral hemorrhagic occlusive vasculitis. Following initial management with systemic corticosteroid, a subsequent unilateral subconjunctival dexamethasone implant, and pars plana vitrectomy, ocular inflammation subsided significantly along with the normalization of IOP. Cytology examination of vitreous samples showed the presence of chronic inflammatory cells in the vitreous. Conclusion: The case highlights the clinical presentation, detailed findings, and successful treatment strategy for hemorrhagic occlusive retinal vasculitis and panuveitis induced by IVT injection of faricimab. Cytopathology analysis of vitreous samples provides novel insights regarding inflammatory mechanisms underlying this rare but potentially sight-threatening complication.