Efficacy of faricimab for recalcitrant multifactorial cystoid macular edema

More information is emerging on faricimab-svoa (faricimab) used for etiologies beyond wet age-related macular degeneration (AMD) and diabetic macular edema (DME), including ongoing trials for use in macular edema following retinal vein occlusion (RVO). This manuscript describes a case of recalcitrant postoperative cystoid macular edema (CME), confounded by a history of branch retinal vein occlusion (BRVO), in which faricimab resulted in resolution of CME after incomplete response to topical anti-inflammation drops, intravitreal aflibercept and bevacizumab, a corticosteroid intravitreal implant, grid laser therapy, and suprachoroidal triamcinolone acetonide (SCS-TA).

An 83-year-old pseudophakic male with history of steroid-induced ocular hypertension and BRVO with mild preoperative CME and visual acuity (VA) of 20/160 presented with significant worsening CME following a pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peel for an epiretinal membrane (ERM) in the right eye. CME persisted for eight years despite treatment with topical anti-inflammatories, anti-VEGF injections, a dexamethasone intravitreal implant, grid laser therapy, and a SCS-TA injection. However, after 3 faricimab injections, CME resolved with a CST change from 748 μm to 339 μm and VA improved from 20/50 to 20/40.

This case demonstrates the effectiveness of faricimab in treatment of CME resistant to other therapies and the importance of continued attempts at using new agents for chronic, recurrent CME. The unique benefits of new agents like faricimab, with both VEGF and Ang-2 inhibition, may be particularly helpful in mixed or inflammatory CME when other proven therapies have failed.