Recurrence of Intraocular Inflammation Following an Aflibercept 8-mg Injection in Eyes With a History of Intraocular...

Vascular endothelial growth factor (VEGF) is critical in various retinal diseases. VEGF inhibitors are a standard treatment for neovascular age-related macular degeneration (AMD). However, intraocular inflammation (IOI) is a major complication after intravitreal administration of second-generation VEGF inhibitors. We report a case of IOI following treatment with aflibercept 8 mg in an eye with a history of IOI due to faricimab. An 83-year-old man was referred to our clinic and diagnosed with type 1 macular neovascularization (MNV), with a previous treatment history of four doses of ranibizumab, 14 doses of aflibercept (2 mg), and two doses of faricimab. The best-corrected visual acuity (BCVA) in the right eye was 0.3 in the decimal format. Treatment was initiated with an as-needed faricimab regimen after three consecutive monthly injections. Thirteen days after the ninth faricimab injection, the patient complained of blurred vision in the right eye. Mild inflammation, with small keratic precipitates (KPs), was observed in the anterior chamber. After topical dexamethasone administration (four times a day), the anterior chamber inflammation resolved one week after treatment. However, exudation recurred 13 weeks after the ninth faricimab administration; therefore, the intravitreal injection was switched to aflibercept 8 mg. Two days after switching to aflibercept 8 mg, the patient complained of pain and blurred vision in the right eye. As with the ninth faricimab injection, mild inflammation was observed in the anterior chamber of the right eye. One week after subtenon triamcinolone acetonide (STTA) and topical dexamethasone, inflammation disappeared in the anterior chamber. In eyes with a history of IOI, careful attention is needed when switching to aflibercept 8 mg from another second-generation VEGF inhibitor, including faricimab.