Severe delayed-onset sterile intraocular inflammation following intravitreal faricimab for neovascular age-related macular degeneration: A case report

Intravitreal faricimab has emerged as an effective treatment for neovascular age-related macular degeneration (nAMD); however, postinjection intraocular inflammation (IOI) remains an important safety concern. We report a case of severe, delayed-onset sterile IOI following intravitreal faricimab in an elderly woman with nAMD. An 84-year-old treatment-naïve patient presented 3 weeks after her fifth faricimab injection with severe ocular pain, profound vision loss, vitritis, diffuse keratic precipitates, and markedly elevated intraocular pressure, closely mimicking infectious endophthalmitis. Comprehensive microbiological evaluation of aqueous and vitreous samples was negative. The patient demonstrated rapid and sustained clinical improvement with intensive topical and systemic corticosteroid therapy. Persistent vitreous debris necessitated pars plana vitrectomy, which confirmed a lymphocyte-predominant sterile inflammatory response. At final follow-up, the visual acuity improved to 6/9 with complete resolution of inflammation. This case highlights the diagnostic challenges of distinguishing sterile IOI from infection and underscores the importance of timely recognition and appropriate management to achieve promising outcomes.