Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.

A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.

Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2–10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.

Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.