Successful management of high-risk proliferative diabetic retinopathy during pregnancy with intravitreal faricimab

Management of proliferative diabetic retinopathy during pregnancy requires balancing maternal vision preservation against uncertain fetal risks associated with intravitreal anti-vascular endothelial growth factor therapy. We report a 27-year-old woman with a chronic type 1 diabetes mellitus who presented at 28 weeks and 1 day of gestation with high-risk proliferative diabetic retinopathy and dense vitreous hemorrhage in the left eye, precluding panretinal photocoagulation. After multidisciplinary counseling regarding limited pregnancy safety data and treatment alternatives, a single intravitreal faricimab injection was administered at 29 weeks and 6 days of gestation. One month later, left eye visual acuity improved from counting fingers to 20/25 with substantial clearance of the vitreous hemorrhage. Cesarean delivery was performed 37 days after injection at 36 weeks and 1 day of gestation for nonreassuring fetal heart tracings. No treatment-attributable adverse event was identified. To our knowledge, this represents the first reported use of intravitreal faricimab during pregnancy.