Progressive intraocular inflammation with anterior scleritis following intravitreal Faricimab for neovascular age-related macular degeneration: a case report

To report a rare and instructive case of intraocular inflammation following intravitreal Faricimab (Vabysmo) injection that progressed to anterior scleritis despite early intervention. While Faricimab is widely used for neovascular age-related macular degeneration (nAMD), understanding its potential for delayed, progressive inflammatory complications is crucial for clinical vigilance. A 74-year-old Asian male with nAMD developed intraocular inflammation following his fifth intravitreal injection of Faricimab, after four prior uneventful injections. The patient initially presented with corneal edema, anterior uveitis, and elevated intraocular pressure (IOP). Although initial treatment with topical corticosteroids and IOP-lowering agents led to partial improvement, the inflammation subsequently progressed, manifesting as persistent vitritis and the development of anterior scleritis. Escalation to systemic corticosteroid therapy was required, which resulted in complete resolution of the inflammation. Faricimab was permanently discontinued, and the patient was successfully switched to Aflibercept (Eylea) without further complications. This case highlights that initially mild anterior segment inflammation following Faricimab injection can progress to more severe ocular inflammation, such as scleritis, despite early topical therapy. Clinicians should maintain close monitoring and a low threshold for escalating to systemic treatment to achieve complete resolution and safeguard visual outcomes. A case of IOI after the fifth Faricimab injection in nAMD, resolved with treatment; underscores the need for vigilance with new anti-VEGF agents.