A recent case study has highlighted a potential association between intravitreal Faricimab (Vabysmo) injections and the development of occlusive retinal vasculitis in a patient with diabetic retinopathy. The 52-year-old male, who had type II diabetes and bilateral non-proliferative diabetic retinopathy complicated by diabetic macular edema, presented with a sudden reduction in vision in his right eye, 35 days after receiving a Faricimab injection. This observation raises concerns about the safety profile of Faricimab, a relatively new treatment option for retinal vascular diseases.
The patient's visual acuity in the right eye had declined from 20/25 to 20/63 following the Faricimab injection. Prior to this episode, both eyes had received six Faricimab injections over a period of seven to eight months, leading to the resolution of macular edema. His HbA1c was 7.9% (63 mmol/mol) at the time of presentation. Ophthalmic examination revealed no cells in the anterior chamber or vitreous in either eye. However, fundus examination of the right eye showed new blot hemorrhages in the temporal periphery and attenuation of both peripheral and central retinal arteries and veins. Optical coherence tomography (OCT) imaging indicated paracentral acute middle maculopathy (PAMM) in the right eye, suggesting ischemia in the intermediate and deep retinal capillary plexuses. The left eye showed mild fluorescein leakage from peripheral veins but was otherwise unremarkable.
Comprehensive screening for retinal vasculitis, including tests for infectious and autoimmune etiologies, yielded unremarkable results. CT-Angiography of the head and neck also showed no abnormalities. Given the diagnosis of occlusive vasculitis, the patient was initially treated with oral prednisolone at 1 mg/kg bodyweight, with a tapering regimen. However, the vascular occlusions progressed despite this treatment. Consequently, the patient received an intravitreal injection of a dexamethasone implant (Ozurdex). Three weeks later, the area of vascular occlusion had stabilized, and visual acuity slightly improved to 20/40 in the right eye and 20/25 in the left eye.
Clinical Implications
This case raises important questions about the potential risks associated with Faricimab injections, particularly the possibility of occlusive retinal vasculitis. While the exact mechanism remains unclear, clinicians should be aware of this potential complication and monitor patients accordingly. Further research is needed to determine the incidence and risk factors for this adverse event. The findings suggest that while Faricimab can be effective in resolving macular edema, vigilance is required to detect and manage potential vascular complications. The case also highlights the importance of considering alternative treatments, such as dexamethasone implants, when initial therapies prove ineffective or are poorly tolerated.
