Successful Management of Refractory toxoplasmosis-related Macular Neovascularization with Intravitreal Faricimab

To describe the therapeutic efficacy of intravitreal faricimab in a refractory case of macular neovascularization (MNV) secondary to toxoplasmic chorioretinitis.

Case report.

A 29-year-old woman presented with decreased vision in her right eye. She had been diagnosed with ocular toxoplasmosis four years earlier and subsequently developed secondary MNV, which was treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Previous intravitreal bevacizumab and aflibercept treatments resulted in minimal functional and anatomical improvement. On examination, best-corrected visual acuity was counting fingers at 2 m in the right eye and 1.0 in the left. Anterior segment findings were unremarkable. Fundus evaluation of the right eye revealed a subfoveal MNV with juxtafoveal hemorrhage and subretinal fluid, confirmed by optical coherence tomography (OCT) and OCT angiography. Due to persistent activation despite prior therapy, a single intravitreal faricimab injection was administered. At three-month post-faricimab injection, visual acuity improved to 0.2, and OCT demonstrated complete resolution of subretinal fluid with a marked decrease in central macular thickness.

In the present case, intravitreal faricimab provided a remarkable anatomical and functional improvement in MNV secondary to toxoplasmic chorioretinitis that had been resistant to previous anti-VEGF treatments. Given its dual inhibition of VEGF-A and Angiopoetin-2, faricimab may offer an additional therapeutic advantage in managing inflammatory neovascular lesions.