Purpose: To report a novel case of hypertensive uveitis with intravitreal faricimab.
Methods: This is a case report. A 69-year-old female undergoing treatment of bilateral diabetic macular oedema with intravitreal faricimab presented for routine review. Ophthalmic examination was performed including visual acuity, intraocular pressure (IOP), gonioscopy, and slit lamp examination. Findings consistent with hypertensive uveitis prompted further infectious/inflammatory/infiltrative uveitis screen.
Results: The patient developed hypertensive uveitis in the left eye (four weeks after the third injection) with an IOP of 42mmHg. Slit lamp examination revealed fine keratic precipitates and mild anterior uveitis. Anterior chamber angle was open on gonioscopy, and there was no vitritis or vasculitis. At review a week later, the patient had developed hypertensive uveitis in the right eye (six weeks after the fourth injection) with IOP of 35mmHg. Slit lamp examination revealed fine keratic precipitates, open angles, and mild vitritis. There was no vasculitis. At both presentations the patient had preserved visual acuity with no significant visual symptoms. The hypertensive uveitis resolved in both eyes with a course of steroid and antihypertensive eye drops. The uveitis screen was negative apart from elevated urine protein (negative beta-2 microglobulin) which could be explained by known diabetes and hypertension.
Conclusion: Hypertensive uveitis is a potential adverse reaction to intravitreal faricimab. This case highlights the importance of monitoring intraocular pressure in patients undergoing treatment with faricimab and emphasises the need for reporting other cases in the community.