Refractory Perifoveal Exudative Vascular Anomalous Complex (PEVAC)- Early Positive Response to Faricimab Therapy

PURPOSE: To describe a case of refractory unilateral PEVAC macular edema initially treated with intravitreal faricimab injections. METHODS: Medical and imaging records were evaluated. Tracked optical coherence tomography (OCT) B scans were reviewed to assess intra-retinal fluid and exudation. RESULTS: A 79-year-old man with unilateral chronic macular edema secondary to PEVAC lesion underwent three monthly intravitreal faricimab injections with completely resolution of the fluid and visual recovery. A presumed thrombotic mechanism of the exudative vascular complex might have occurred in this case. CONCLUSION: After conducting a literature review on June, 2025, utilizing PubMed and Google Scholar, using the key words PEVAC, LRCA and faricimab therapy, there wasn't any prior reports of PEVAC case treated by a bi-specific antibody directed against Ang2 and VEGF (faricimab). Though, limitted by a short follow-up time (9 months), this unique clinical experience should be shared to inform that faricimab may lead to early remarkable anatomical and functional improvement in eyes with no responsive PEVAC lesions.