Faricimab-Associated Intraocular Inflammation With Features of Herpes Simplex Virus

Area of Science:

• Ophthalmology
• Immunology
• Virology

Background:

• Faricimab is a novel bispecific antibody targeting Angiopoietin-2 and VEGF-A.
• Intraocular inflammation (IOI) is an emerging concern following faricimab therapy.
• Understanding the clinical profile of severe IOI is critical for patient management.

Purpose of the Study:

• To investigate the clinical features, management strategies, and outcomes of severe IOI post-faricimab.
• To specifically assess for features suggestive of herpes simplex virus (HSV) reactivation in these cases.
• To explore potential mechanisms underlying faricimab-associated IOI.

Main Methods:

• Retrospective, single-center case series of five patients (five eyes) with severe IOI after faricimab.
• Patients received faricimab for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME).
• Clinical data, including visual acuity, intraocular pressure, anterior chamber inflammation, and viral markers, were analyzed.

Main Results:

• All patients presented with anterior chamber inflammation and elevated intraocular pressure.
• Consistent features of HSV keratouveitis were observed in all cases, including dendritic ulcers and granulomatous keratic precipitates.
• Treatment with steroids and antivirals led to inflammation resolution in 15.5 days, but 80% did not regain baseline vision.

Conclusions:

• A previously unreported association between faricimab-associated IOI and HSV reactivation is identified.
• The findings suggest a potential role for altered ocular immune surveillance, possibly linked to VEGF-A and Ang-2 inhibition.
• Clinicians should consider viral mechanisms in the differential diagnosis and management of faricimab-associated IOI.