Faricimab-associated hypertensive uveitis - a case report

Background Faricimab (Vabysmo™, Roche/Genentech, Basel, Switzerland) is a humanized, bispecific monoclonal antibody which binds and inhibits both angiopoietin-2 and all vascular endothelial growth factor (VEGF)-A isoforms. It has been approved for the treatment of neovascular age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. Given that faricimab-associated intraocular inflammation is increasingly documented in recent large cohorts [1–6], the primary novelty of this report lies in the detailed serial photographic documentation of the morphological evolution and complete resolution of the granulomatous keratic precipitates over a 5-month follow-up period. Methods A retrospective chart review was conducted to extract clinical data, multimodal imaging, and serial slit-lamp photographs of a patient who developed intraocular inflammation following faricimab therapy. The Standardization of Uveitis Nomenclature (SUN) criteria and the Naranjo Probability Scale were applied to grade the inflammation and assess the likelihood of the adverse drug reaction, respectively. Results Ten days after her seventh faricimab injection, the patient presented with vision loss, mild eye pain, increased intraocular pressure, mutton-fat keratic precipitates, and unilateral granulomatous anterior and intermediate uveitis. The condition was successfully managed with topical corticosteroids and hypotensive eye drops, leading to complete clinical resolution. The adverse drug reaction was considered probable; however, aqueous humor viral testing was not performed, leaving viral etiology as an unexcluded alternative diagnosis. Conclusion This observation contributes to the understanding of faricimab’s real-world safety profile. While it highlights a potential risk of delayed-onset intraocular inflammation, infectious etiologies must be strictly evaluated before definitively attributing such events to the drug, emphasizing the need for ongoing monitoring and research.