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Severe Intraocular Inflammation Following Intravitreal Faricimab.

Loka Thangamathesvaran¹, Jun Kong¹, Susan B Bressler¹

¹Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

JAMA Ophthalmology

|February 29, 2024

Summary

Three patients experienced severe intraocular inflammation (IOI) after receiving intravitreal faricimab injections. This case series highlights the need for continued monitoring of faricimab

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Area of Science:

Ophthalmology
Retinal Diseases
Pharmacology

Background:

Intraocular inflammation (IOI) monitoring is crucial for assessing the safety of new intravitreal agents.
Newer agents like brolucizumab, pegcetacoplan, and faricimab require careful risk-benefit evaluation in clinical practice.
Limited trial data necessitates post-market surveillance for rare adverse events.

Purpose of the Study:

To describe three cases of acute, severe, posterior-segment IOI following intravitreal faricimab injections.
To report initially culture-negative IOI events occurring within a short timeframe at a single institution.
To contribute to the understanding of potential risks associated with faricimab therapy.

Main Methods:

A case series design was employed to document patient experiences.
Three patients presenting with severe IOI post-faricimab injection were identified.
Diagnostic procedures included visual acuity assessment, vitreous taps for cultures, and retinal imaging.

Main Results:

Three patients developed acute, severe anterior and posterior segment IOI within 3-4 days of intravitreal faricimab injection.
Vitreous cultures were negative in all initial taps; one patient's vitrectomy culture showed a likely contaminant.
Symptoms resolved within one month, with varying degrees of visual acuity recovery.

Conclusions:

This cluster of severe IOI cases following intravitreal faricimab suggests events may be more frequent than trial data indicate.
Potential unknown storage or handling issues could be implicated in these inflammatory events.
Vigilance in detecting and reporting IOI cases post-faricimab is essential for patient safety.