# Severe intraocular inflammation after intravitreal injection of faricimab: a single-site case series of six patients

Inès Ben Ghezala, Pierre-Henry Gabrielle, Maxime Sibert, Laure-Anne Steinberg, Anne Dautriche, Louis Arnould, Catherine Creuzot-Garcher

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Inès Ben Ghezala, Pierre-Henry Gabrielle, Maxime Sibert, Laure-Anne Steinberg, Anne Dautriche, et al.. Severe intraocular inflammation after intravitreal injection of faricimab: a single-site case series of six patients. American Journal of Ophthalmology, 2025, 269, pp.11-19. 10.1016/j.ajo.2024.08.008. hal-04676638

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Distributed under a Creative Commons Attribution 4.0 International License
Severe Intraocular Inflammation After
Intravitreal Injection of Faricimab: A
Single-Site Case Series of Six Patients

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INÈS BEN GHEZALA, PIERRE-HENRY GABRIELLE, MAXIME SIBERT, LAURE-ANNE STEINBERG, ANNE DAUTRICHE, LOUIS ARNOULD, AND CATHERINE CREUZOT-GARCHER

* PURPOSE: To describe the patient characteristics and clinical course of severe intraocular inflammation (IOI) following intravitreal injection (IVT) of faricimab.

* DESIGN: Retrospective case series.

* METHODS: Case series at a single French academic center (Dijon University Hospital) where 263 patients were treated with faricimab IVT between January 9, 2024 and May 7, 2024.

* RESULTS: Over the 4-month period, a total of 1659 eyes (1338 patients) received anti-vascular endothelial growth factor (anti-VEGF) IVTs for a total of 3510 IVTs, of which 343 eyes (263 patients) received faricimab IVTs for a total of 971 IVTs. Overall, 6 pretreated eyes with neovascular age-related macular degeneration that were switched to faricimab developed severe unilateral IOI following faricimab IVT (1/162 injections [0.62%]), including 5 eyes presenting with a severe anterior and intermediate uveitis mimicking infectious endophthalmitis. All eyes were normotensive and presented with mild to moderate pain and predominantly moderate vitritis, associated with granulomatous keratic precipitates in 2 eyes and nonocclusive vasculitis in one eye. The clinical presentation, sterile vitreous sample culture, and rapid improvement with treatment made the diagnosis of infectious endophthalmitis unlikely. Four patients out of 6 did not recover their pre-IOI visual acuity, with an average visual loss of +0.2 logMAR. Two patients had positive antinuclear antibodies, including one with a history of cus-taneous lupus.

* CONCLUSIONS: In this case series, we reported 6 cases of severe IOI after intravitreal faricimab over 4 months in a single French center with an estimated incidence rate of 0.6% per injection. Future real-world data will contribute

to a better evaluation of the epidemiology of this rare inflammatory adverse event related to intravitreal faricimab. (Am J Ophthalmol 2025;269: 11–19. © 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/))

NTRAVITREAL VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) inhibitor therapy has been a game-changer in the management of retinal diseases for the past 2 decades. First-generation intravitreal anti-VEGF agents include bevacizumab and ranibizumab, which both target VEGF-A, and aflibercept, which targets VEGF-A and placental growth factor (PlGF).¹⁻³ Unfortunately, many patients have a poor response to approved VEGF inhibitors and require intravitreal injections (IVTs) of VEGF inhibitor every 4 to 8 weeks to maintain their vision in the long term.⁴,⁵ Novel long-acting drug agents have been recently approved for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), such as brolucizumab, faricimab, or high dose-aflibercept.⁶⁻⁸

However, the first reports of severe drug-induced intraocular inflammation (IOI) using these novel long-acting drugs appeared in February 2020, a few months after brolucizumab had been approved and marketed.⁹,¹⁰ Drug-induced IOI was rare, varying from 0.01% to 0.16%, using the 3 first-generation VEGF inhibitors in trials and real-world data.¹¹⁻¹³

Faricimab (Vabysmo) is a monoclonal immunoglobulin G (IgG)1-like antibody that targets both VEGF-A and angiopoietin-2 (ANG-2).¹⁴ Noninferiority phase III RCTs for nAMD and DME reported good visual and anatomical efficacy with faricimab with adjustable dosing for up to 16 weeks, highlighting its extended durability.⁷,¹⁵ Faricimab was well tolerated for over 1 year, with a similar rate of adverse ocular events between the faricimab and aflibercept treatment arms. From these data, the Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved faricimab for the treatment of nAMD and DME in 2022.¹⁶,¹⁷ In France, Vabysmo® has been fully reimbursed by health insurance since December 2023.¹⁸ However, with the introduction of faricimab in routine clinical practice, new concerns of IOI have been

Accepted for publication August 5, 2024.

From the Ophthalmology Department (I.B.G., P-H.G., M.S., L-A.S., L.A., C.C-G.), University Hospital, Dijon, France; Inserm, CIC 1432 (I.B.G.), Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Eye and Nutrition Research Group (P-H.G., C.C-G.), CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France; Burgundy Regional Pharmacovigilance Center (A.D.), University Hospital, Dijon, France

Inquiries to: Inès Ben Ghezala, Ophthalmology Department, Dijon University Hospital, Dijon, France; e-mail: ines.ben-ghezala@chu-dijon.fr
raised.<sup>19-23</sup> The present article describes the clinical course and patient characteristics of severe IOI following faricimab IVT in a French single-center case series. All patients were treated with faricimab in the Côte d'Or department (Burgundy).

## PATIENTS AND METHODS

This article is a retrospective case review of patients who were diagnosed with severe IOI after an IVT of faricimab between January 9, 2024 and May 7, 2024 in Dijon University Hospital. All patients included were previously informed and consented for treatment and participation in the research. This study adhered to the tenets of the Declaration of Helsinki and to the European General Data Protection Regulation.

Six cases of severe IOIs were identified, including 5 cases of severe anterior and intermediate uveitis mimicking endophthalmitis. The patients' characteristics and clinical presentations are summarized in Table 1.

* **CASES:** Between January 9, 2024 and May 7, 2024, a total of 1659 eyes (1338 patients) received anti-VEGF IVTs for a total of 3510 IVTs, of which 343 eyes (263 patients) received faricimab IVTs for a total of 971 IVTs, 358 eyes (311 patients) received ranibizumab IVTs for a total of 693 IVTs, and 958 eyes (764 patients) received aflibercept IVTs for a total of 1846 IVTs. We report 6 (per 971 IVTs [0.62%]) cases of severe IOIs following faricimab IVTs.

* **PATIENT 1:** An 89-year-old female patient presented with moderate pain, redness, and visual loss in her right eye that started on the day after her first faricimab IVT. Before faricimab, the patient had been treated for nAMD with aflibercept and ranibizumab for 8 years and for 3 months, respectively, with a BCVA of 20/160 in her right eye. Five days after her first faricimab IVT, the patient presented to the ophthalmology department. Her right eye showed redness, 4+ anterior chamber (AC) cells and 2+ vitritis. Intraocular pressure (IOP) measured by air tonometry was 10 mmHg. Ultrasound revealed dense vitreous echoes with an attached retina. The visual acuity of the patient was "hand motion."

As endophthalmitis was initially suspected, vitreous samples were acquired and analyzed. The patient received 2 antibiotic IVTs: vancomycin 1 mg/0.1 mL and ceftazidime 2 mg/0.1 mL, and 48 h later, vancomycin 1 mg/0.1 mL, ceftazidime 2 mg/0.1 mL, and betamethasone: 0.4 mg/0.1 mL. She was then treated with topical and subconjunctival steroids. Vitreous cultures remained negative. The clinical evolution was favorable and 1 month after the onset of the IOI, the patient recovered her baseline visual acuity (20/160). Given the negative vitreous cultures, the favorable outcome and the absence of hypopyon and

fibrin, the final diagnosis was an anterior and intermediate uveitis mimicking infectious endophthalmitis (pseudoendophthalmitis). At 2 and 4 months after the onset of the uveitis, the patient received further faricimab IVTs. No adverse event was reported. The visual acuity at 4 months was 20/160.

* **PATIENT 2:** An 81-year-old female patient presented with mild pain, redness, and a decrease in vision in her right eye starting 20 days after her second faricimab IVT. Before faricimab, the patient had been treated for nAMD with ranibizumab and aflibercept for 2 and for 3 years, respectively, with a BCVA of 20/25 in her right eye. The patient presented to the ophthalmology department 21 days after her second faricimab IVT. Her right eye showed redness, 3+ AC cells and 1+ vitritis. The IOP was 10 mmHg. Fluorescein and indocyanine green angiography did not reveal any retinal vasculitis or papillitis. The patient's visual acuity was 20/40.

Endophthalmitis was initially suspected and vitreous samples were acquired and analyzed. The patient underwent 2 series of IVTs: vancomycin and ceftazidime on the first day, and 48 h later, vancomycin, ceftazidime, and betamethasone. The patient presented with granulomatous keratic precipitates, and therefore oral valaciclovir was prescribed for 10 days. She was then treated with topical and subconjunctival steroids. Vitreous cultures remained negative.

The clinical evolution was partially favorable and the patient recovered 20/50 visual acuity 10 days after the onset of the anterior and intermediate uveitis. As spectral domain optical coherence tomography (SD-OCT) showed a persistent exudative retinal detachment, the patient underwent IVT with aflibercept. One month after the aflibercept IVT, the patient presented with an inflammatory flare-up with increased vitritis, papillitis, and mild vasculitis (vascular sheathings without diffusion in fluorescein angiography; Figure 1). New vitreous samples were analyzed. The patient underwent 2 further series of IVTs: vancomycin and ceftazidime on the first day, and 48 h later, vancomycin, ceftazidime, and betamethasone. Topical and subconjunctival steroids were resumed after that. Additional bacterial polymerase chain reaction (PCR) analysis of the vitreous sample reported the presence of Micrococcus sp. The presence of Micrococcus was interpreted as probable contamination, given that Micrococcus does not usually cause endophthalmitis and is abundant in the environment<sup>24,25</sup> and given the one-month delay between the last IVT and the inflammatory flare-up, which was far longer than the 4 days median delay from IVT to endophthalmitis.<sup>26</sup> The evolution was slowly favorable. The patient recovered 20/32 BCVA 11 weeks after the second uveitis onset.

An infectious and autoimmune workup was performed in light of this recurrent intermediate uveitis. The result of the infectious workup was negative, but the autoimmune
<table><caption>TABLE 1. Demographic and Clinical Characteristics, Ocular Features, Treatment, and Outcome of Patients Presenting With Severe Intraocular Inflammation After Faricimab Intravitreal Injection From January to May 2024 in Dijon University Hospital</caption><thead><tr><th>Case</th><th>M/F</th><th>Farinicab indication</th><th>Age</th><th>No. Of Faricimab IVTs</th><th>Number of days between last Faricimab IVT and IOI Onset</th><th>OD/OS</th><th>Baseline VA</th><th>IOP (mmHg)</th><th>Onset of IOI</th><th>Clinical Presentation</th><th>IOP at the Onset of IOI (mmHg)</th><th>Vitreous culture</th><th>Treatment</th><th>Further IVTs</th><th>Ocular Outcome</th><th>Duration of Follow-up Since Intraocular Inflammation (weeks)</th></tr></thead><tbody><tr><td>1</td><td>F</td><td>nAMD</td><td>89</td><td>1</td><td>1</td><td>OD</td><td>20/160</td><td>13</td><td>HM</td><td>4+ AC cells 2+ Vitritis</td><td>10</td><td>Sterile</td><td>IVT Antibiotics and Betamethasone Topical and Subconjunctival Steroids</td><td>2 Faricimab IVT</td><td>20/160</td><td>16</td></tr><tr><td>2</td><td>F</td><td>nAMD</td><td>81</td><td>2</td><td>20</td><td>OD</td><td>20/25</td><td>11</td><td>20/40</td><td>Granulomatous keratic precipitates 3+ AC cells 1+ Vitritis Vasculitis</td><td>10</td><td>1st tap: Sterile 2nd tap: Micrococcus sp. (interpreted as contamination)</td><td>IVT Antibiotics and Betamethasone Oral valaciclovir Topical and Subconjunctival Steroids</td><td>1 Afilibercept IVT</td><td>20/32</td><td>11</td></tr><tr><td>3</td><td>F</td><td>nAMD</td><td>82</td><td>2</td><td>8</td><td>OD</td><td>20/40</td><td>19</td><td>CF</td><td>4+ AC cells, 3+ Vitritis</td><td>17</td><td>Sterile</td><td>IVT Antibiotics and Betamethasone Topical and Subconjunctival Steroids</td><td>None</td><td>20/80</td><td>2</td></tr><tr><td>4</td><td>M</td><td>nAMD</td><td>78</td><td>4</td><td>7</td><td>OS</td><td>20/63</td><td>22</td><td>20/200</td><td>3+ AC cells, 1+ Vitritis</td><td>15</td><td>Sterile</td><td>IVT Antibiotics and Betamethasone Topical and Subconjunctival Steroids</td><td>None</td><td>20/160</td><td>2</td></tr><tr><td>5</td><td>F</td><td>nAMD</td><td>76</td><td>5</td><td>1</td><td>OS</td><td>20/32</td><td>15</td><td>20/600</td><td>4+ AC cells, 2+ Vitritis</td><td>20</td><td>Sterile</td><td>IVT Antibiotics and Betamethasone Topical and Subconjunctival Steroids</td><td>None</td><td>20/50</td><td>5</td></tr><tr><td>6</td><td>F</td><td>nAMD</td><td>90</td><td>5</td><td>1</td><td>OD</td><td>20/63</td><td>14</td><td>20/125</td><td>Granulomatous keratic precipitates 4+ AC cells</td><td>18</td><td>Not performed</td><td>IVT Antibiotics and Betamethasone Topical and Subconjunctival Steroids</td><td>None</td><td>20/63</td><td>2</td></tr></tbody></table>

IVT = intravitreal injection; IOI = intraocular inflammation; VA = visual acuity; IOP = intraocular pressure; nAMD = neovascular age-related macular degeneration; HM = Hand Motion; CF = Counting Fingers; AC = anterior chamber.
<figure><img src="image_4.png" /><figcaption>FIGURE 1. (A) Color retinal photography of the right eye of patient 2 demonstrating vitritis and vascular sheathings. (B) Fluorescein angiography of the right eye of patient 2 demonstrating vitritis, papillitis, and a mild vasculitis.</figcaption></figure>

workup reported positive antinuclear antibodies (ANAs) at 1:320 and positive anti-Sjögren's-syndrome-related antigen A (anti-SSA) autoantibodies.

* PATIENT 3: An 82-year-old female patient presented with moderate pain, redness, and visual loss in her right eye starting 8 days after her second faricimab IVT. Before faricimab, the patient had been treated for nAMD with ranibizumab and aflibercept for 6 months and for 5 years, respectively, with a BCVA of 20/40 in her right eye. At 10 days after her second faricimab IVT, the patient presented to the ophthalmology department. Her right eye presented redness, 4+ AC cells and 3+ vitritis. The visual acuity was "counting fingers," While IOP was 17 mm Hg Fluorescein and green indocyanine angiography did not reveal any vasculitis.

Endophthalmitis was initially suspected and vitreous samples were acquired and analyzed. The patient underwent 2 series of IVTs: vancomycin and ceftazidime on the first day, and 48 hours later, vancomycin, ceftazidime, and betamethasone. She was then treated with topical and subconjunctival steroids. Vitreous cultures remained negative.

The clinical evolution was favorable. At 11 days after the onset of anterior and intermediate uveitis, the patient recovered 20/80 BCVA.

* PATIENT 4: A 78-year-old male patient presented with a mildly painful left eye with redness and a decrease in vision starting 7 days after his fourth faricimab IVT. Before faricimab, the patient had been treated for nAMD with ranibizumab and aflibercept for 1 year and 10 years, respectively, with BCVA measured as 20/63 in his left eye. The patient presented to the ophthalmology department 12 days after his fourth faricimab IVT. His left eye presented red-

ness, 3+ AC cells and 1+ vitritis. IOP was 15 mmHg. The visual acuity was 20/200. Fluorescein angiography did not reveal any vasculitis.

Endophthalmitis was initially suspected and vitreous samples were acquired and analyzed. The patient underwent 2 series of IVTs: vancomycin and ceftazidime on the first day, and 48 hours later, vancomycin, ceftazidime, and betamethasone. He was then treated with topical and subconjunctival steroids. Vitreous cultures remained negative.

The clinical evolution was partially favorable. At 14 days after the onset of the anterior and intermediate uveitis, the patient had recovered 20/160 BCVA.

* PATIENT 5: A 76-year-old female patient presented with pain, redness, and loss of vision in her left eye on the day after her fifth faricimab IVT. Before faricimab, the patient had been treated for nAMD with ranibizumab and aflibercept, with her BCVA measured as 20/32 in her left eye. Four days after her fifth faricimab IVT, the patient presented to the ophthalmology department. Her left eye presented redness, 4+ anterior chamber (AC) cells and 2+ vitritis. IOP was 20 mmHg BCVA was 20/600 in her left eye.

Endophthalmitis was initially suspected and vitreous samples were acquired and analyzed. The patient underwent 2 series of IVTs: vancomycin and ceftazidime on the first day, and 48 h later, vancomycin, ceftazidime and betamethasone. She was then treated with topical and subconjunctival steroids. Vitreous cultures remained negative.

The clinical evolution was slowly and slightly favorable. Given the favorable evolution, sterile vitreous samples, and the absence of hypopyon and fibrin, the final diagnosis was an anterior and intermediate uveitis. Five
<figure><img src="image_5.png" /><figcaption>FIGURE 2. Slit-lamp view of the right eye of patient 6 demonstrating granulomatous keratic precipitates.</figcaption></figure>

weeks after the onset of the uveitis, the patient's BCVA was 20/50.

* PATIENT 6: A 90-year-old female patient presented with painless floaters in her right eye that started on the day following her fifth faricimab IVT. The patient had a history of cutaneous lupus with positive antinuclear antibodies (ANAs) at ≥ 1:1280 and positive anti-double-stranded (anti-dsDNA) autoantibodies. She was previously treated with oral hydroxychloroquine and steroid ointment for cutaneous lupus. Before faricimab, the patient had been treated for nAMD with aflibercept for 5 years, with BCVA measured as 20/63 in her right eye. Four days after her fifth faricimab IVT, the patient presented to the ophthalmology department for floaters and visual loss without redness or pain in her right eye. BCVA was 20/125. Her right eye presented white granulomatous keratic precipitates and 4+ AC cells (Figure 2). The IOP was 18 mm Hg. No vitritis was observed. Treatment with topical steroids and subconjunctival steroids was initiated, with close daily clinical monitoring to avoid missing any signs of potential endophthalmitis. The clinical evolution was favorable. At 13 days after the onset of the anterior uveitis, the patient recovered her baseline BCVA (20/63). Given the presence of granulomatous keratic precipitates, the absence of hypopyon, fibrin or vitritis and the favorable outcome, the final diagnosis was an anterior uveitis and an infectious endophthalmitis was ruled out.

DISCUSSION

Here, we report a case series of 6 patients who presented with severe IOI, including 5 cases of severe anterior and intermediate uveitis mimicking endophthalmitis, between January 9, 2024 and May 7, 2024 in Dijon University Hospital out of a total of 263 patients (971 IVTs) who were treated with intravitreal faricimab; that is, an incidence of severe IOIs of 0.6% per IVT and a cumulative incidence of 2.3% per patient over 4 months of treatment with faricimab. During that period, we performed 1846 and 693 IVTs for 764 and 311 patients with aflibercept and ranibizumab, respectively, without any case of IOI or endophthalmitis.

Most patients had mild to moderate painful eyes. Overall, 33% (2/6) of the patients with severe IOI after a faricimab IVT presented with granulomatous uveitis, and 17% (1/6) presented with retinal vasculitis. No patient developed hypertensive uveitis in our case series although several cases of hypertensive uveitis following faricimab IVT have been described in other centers.²²,²⁷ In our case series, 33% (2/6) of the patients had raised IOP compared to baseline (Table 1). As IOI was severe, including vitritis in 5 cases, these patients were initially considered to have infectious endophthalmitis and were treated accordingly. Given the clinical presentation (mild to moderate pain, presence of
Fourth, these severe IOIs could be induced by an immune
reaction to faricimab. Brolucizumab, a second-generation,
longer-lasting anti-VEGF-A agent, induced some severe
and relatively frequent IOIs (approximately 4%), which
were observed from clinical trials onwards.<sup>39,40</sup> The exact
pathogenic mechanism of these inflammations remains un-
known, although several hypotheses were suggested, such
as the formation of anti-drug antibodies or hypersensi-
tivity reactions.<sup>41</sup> Busch et al.<sup>42</sup> analyzed serum samples
from 192 patients with a variety of ophthalmologic con-
ditions and vitreous samples from 54 patients who under-
went vitrectomy: brolucizumab anti-drug antibodies sig-
nals were present in 20.4% and 13.0% of serum and vitre-
ous samples, respectively, vs. 2.6% and 0% for ranibizumab
anti-drug antibodies in serum and vitreous samples, respec-
tively. Faricimab could be subject to the same immune or
hypersensitivity reactions. In clinical studies investigating
faricimab, plasma treatment-emergent anti-drug antibodies
were reported in 8% to 10% of the patients.<sup>43</sup> However,
the relationship between anti-drug antibodies and IOI re-
mains unknown. Future studies must confirm these patho-
physiological hypotheses. Of note, 2 of our 6 patients had
positive ANAs, including 1 patient previously diagnosed
with cutaneous lupus, which could probably promote an
autoimmune reaction. As recommended for brolucizumab,
faricimab should be carefully prescribed or even avoided
in patients with a history of systemic autoimmune diseases
or prior uveitis.<sup>17,44</sup> A systematic autoimmune workup for
all patients presenting with severe IOIs following faricimab
IVTs could allow us to identify potential autoimmune pre-
dispositions.

To conclude, we reported a case series of 6 patients who
presented with severe IOI, including 5 patients with se-
vere anterior and intermediate uveitis mimicking endoph-
thalmitis, after an IVT of faricimab between January 9, 2024
and May 7, 2024 in Dijon University Hospital, that is, an
incidence of 0.6% per IVT. There appears to be a likely in-
creased risk of severe IOI after intravitreal faricimab com-
pared with first-generation intravitreal anti-VEGF agents.
The safety of intravitreal faricimab should be carefully mon-

itored in the following months and years. As for infectious
endophthalmitis, patients should be educated about the
symptoms of IOI that require urgent consultation (redness,
pain, floaters, and loss of vision). Ophthalmologists also
need to be aware of the importance of avoiding faricimab in
patients with a history of autoimmune disease or uveitis. Pa-
tients treated with faricimab should be closely monitored,
with IOP measurement, slit-lamp examination searching
for keratic precipitates, and dilated fundus examination
searching for vitritis. Ophthalmologists should be aware
that some clinical features – such as mild pain, the pres-
ence of granulomatous keratic precipitates, the absence of
hypopyon or fibrin in the anterior chamber, and moderate
vitritis allowing visualization of the fundus – may suggest
an intraocular inflammation rather than an infectious en-
dophthalmitis. Although no case of hypertensive uveitis
was observed in our case series, ocular hypertension may
also be a warning sign of intraocular inflammation. For our
6 patients, a treatment with topical and subconjunctival
steroids led to a regression of inflammation with partial
or total visual recovery. No treatment with oral steroids
was necessary. We encourage clinicians who encounter se-
vere IOI after faricimab IVTs to report it to pharmacovig-
ilance as it is introduced in routine clinical practice. Fur-
ther real-world pharmacoepidemiological studies will help
to better assess and quantify this risk of severe IOI following
faricimab IVT.

CREDIT AUTHORSHIP CONTRIBUTION STATEMENT

**Inès Ben Ghezala:** Writing – original draft, Data curation, Conceptualization. **Pierre-Henry Gabrielle:** Writing – review & editing, Data curation. **Maxime Sibert:** Data curation. **Laure-Anne Steinberg:** Data curation. **Anne Dautriche:** Investigation. **Louis Arnould:** Writing – review & editing. **Catherine Creuzot-Garcher:** Writing – review & editing, Investigation, Conceptualization.

Funding/Support: This project did not receive any external funding. Financial Disclosures: I.B.: consultant fees from Horus Pharma. P.-H.G.: travel expenses from Théa Pharma, AbbVie/Allergan, Bayer, and Novartis and consultant fees from Novartis, Roche, AbbVie/Allergan, Horus Pharma, Zeiss Meditec, and Bayer. C.C.-G.: consultant fees from AbbVie/Allergan, Bayer, Horus Pharma, Novartis, Roche, Alcon, and Théa Pharma. All authors attest that they meet the current ICMJE criteria for authorship.

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