Hypertensive Anterior Uveitis Following Intravitreal Faricimab

Describe findings of three cases of culture and PCR negative hypertensive anterior uveitis following intravitreal faricimab.

This is a case series of three patients undergoing treatment for diabetic macular edema (DME) or neovascular age-related macular degeneration (nAMD). Data collected included visual acuity, intraocular pressure (IOP), slit lamp examination (SLE), anterior chamber (AC) tap, vitreous tap with culture, and fluorescein angiography (FA).

Three patients developed hypertensive uveitis following repeated intravitreal faricimab injections for DME or nAMD. All presented within 2-5 weeks of injection with ocular pain and redness. Exam revealed elevated intraocular pressure (22-52 mmHg), and keratic precipitates with anterior chamber inflammation. Infectious and inflammatory workups, including aqueous and/or vitreous PCR for HSV, VZV, and CMV, were negative in all cases. Faricimab was discontinued and topical and/or local corticosteroids initiated, with adjunctive IOP-lowering therapy as indicated. Inflammation resolved in all patients within 3 months without recurrence after switching intravitreal anti-VEGF agents. Final visual acuity ranged from 20/25 to count fingers, limited by glaucomatous optic neuropathy in one case.

Hypertensive anterior uveitis with diffuse KPs is a potential rare complication of intravitreal faricimab and must be considered in patients presenting with new ocular inflammation or IOP elevation while undergoing treatment with faricimab. The intraocular inflammation appears to respond well to discontinuation of faricimab and treatment with local corticosteroids.