Intraocular Inflammation After Intravitreal Faricimab Injections: A Case Series

BACKGROUND: Intraocular inflammation (IOI) is a rare but potentially sight-threatening complication that can occur after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. This adverse event has been under scrutiny in recent years due to an increased incidence, particularly with some of the newer anti-VEGF agents, such as Brolucizumab. Faricimab is a new anti-VEGF medication that has been approved by the United States Food and Drug Administration. As it is relatively new on the market, long-term safety data is still being collected. METHODS: This is a retrospective case series of 8 eyes in 5 patients with IOI that occurred after faricimab intravitreal injections. RESULTS: All patients were diagnosed with significant uveitis with anterior vitreous involvement and 4 out of the 5 patients presented subacutely with high intraocular pressure while the remaining patient presented acutely within 4 days following IVT with normal intraocular pressure. The patients received, on average, 4.875 faricimab injections prior to development of IOI and the inflammation resolved in all patients following cessation of faricimab injections and initiation of oral and topical non-steroidal anti-inflammatory agents and topical steroids. CONCLUSION: Non-infectious hypertensive uveitis can occur subacutely after intravitreal faricimab injections. It is imperative that intraocular pressure is promptly managed to reduce the risk of permanent glaucomatous damage. As all our patients presented with anterior vitreous involvement, it is also practical that such cases of IOI are not mistaken for infectious exogenous endophthalmitis to avoid unnecessary treatment with intravitreal antibiotics and surgery.