Central Retinal Artery Occlusion After Intravitreal Injection of Faricimab: A Case Report

Faricimab is a relatively novel agent as a bispecific antibody that inhibits both vascular endothelial growth factor-A and angiopoietin-2. Although it's effective for several retinal diseases, several rare adverse events, such as retinal vasculitis, have been reported. We present a case of central retinal artery occlusion (CRAO) following intravitreal injection of faricimab in a 74-year-old woman treated for central retinal vein occlusion. A sudden decrease in visual acuity occurred 24 hours after the second injection. Her best-corrected visual acuity was counting fingers at 30 cm. No anterior chamber inflammation was observed. Fundus examination showed retinal whitening at the posterior pole. Optical coherence tomography revealed intraretinal edema, and fluorescein angiography showed mild perfusion delay without leakages from retinal vessels. She was diagnosed with CRAO. After one month, her vision remained at 0.01. This case highlights that CRAO may occur as a rare but serious vascular adverse event following faricimab injection. Ophthalmologists should be aware of this potential complication and counsel patients accordingly.