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Clinical Pharmacy and Pharmacology

Choroidal Detachment After Intravitreal Injection of Faricimab

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1 Credit CME

JAMA Ophthalmology

Published Online: September 21, 2023

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Article Information and Disclosures

Etienne M. Schönbach, MD¹;

William R. Freeman, MD¹

Author Affiliations

¹Jacobs Retina Center at the Shiley Eye Institute, University of California, San Diego, San Diego

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A 70-year-old White emmetropic female patient with neovascular age-related macular degeneration had received aflibercept intravitreal injections without complications over years. One day after an uneventful first injection of faricimab using a superonasal pars plana approach and a 30-gauge needle, she presented with pain and a subjective visual field defect. She had stable visual acuity of 20/400 OS, hypotony (intraocular pressure of 3 mm Hg), and a suprachoroidal hemorrhage (SCH) (Figure). Patching and application of tobramycin-dexamethasone ophthalmic ointment were recommended. The hypotony resolved within days, and the SCH resolved 2 months after injection. Visual acuity remained 20/400 OS. Suprachoroidal hemorrhages after intravitreal injections using small-gauge needles have been reported but are rare.¹^- 3 Risk factors for SCH include anticoagulation⁴ and high myopia,⁵ but these were not present in this patient, where postinjection ocular hypotony may have been the initial event leading to rupture of ciliary artery branches⁶ with subsequent SCH. This limited, nonappositional case of SCH resolved without surgery.

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Article Information

Corresponding Author: Etienne Schönbach, MD, Jacobs Retina Center at the Shiley Eye Institute, University of California, San Diego, 9415 Campus Point Dr, La Jolla, CA 92093 (eschoenbach@hotmail.de).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

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Brouzas D , Koutsandrea C , Moschos M , Papadimitriou S , Ladas I , Apostolopoulos M . Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin) for AMD followed by contralateral sympathetic ophthalmia. Clin Ophthalmol. 2009;3:457-459. doi:10.2147/OPTH.S4641 PubMed Google Scholar Crossref

Meyer CH , Brinkmann CK , Helb HM . Choroidal detachment after an uneventful intravitreal injection. J Ocul Pharmacol Ther. 2010;26(3):305-307. doi:10.1089/jop.2009.0128 PubMed Google Scholar Crossref

Chandra A , Xing W , Kadhim MR , Williamson TH . Suprachoroidal hemorrhage in pars plana vitrectomy: risk factors and outcomes over 10 years. Ophthalmology. 2014;121(1):311-317. doi:10.1016/j.ophtha.2013.06.021 PubMed Google Scholar Crossref

Tabandeh H , Sullivan PM , Smahliuk P , Flynn HW Jr , Schiffman J . Suprachoroidal hemorrhage during pars plana vitrectomy—risk factors and outcomes. Ophthalmology. 1999;106(2):236-242. doi:10.1016/S0161-6420(99)90062-3 PubMed Google Scholar Crossref

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.