Expert Opinion: Management of Intraocular Inflammation and Vasculitis After Intravitreal Pegcetacoplan for Geographic...

This expert opinion review is intended to provide guidelines for diagnosis and management of intraocular inflammation (IOI) and vasculitis following pegcetacoplan.

A case series of all post-marketing reports classified by experts as definite or suspected vasculitis over an 18-month period was assessed.

A total of 306,000 pegcetacoplan intravitreal injections were given in the real world between March 1, 2023, and August 31, 2024. Twenty-four eyes from 22 patients (mean age 76 years, 59% female) with definite or suspected vasculitis were evaluated. Comorbidities included hypertension (55%), hypothyroidism (27%), and recent COVID-19 infection (14%). Twelve eyes were classified as vasculitis with occlusion, seven as vasculitis without occlusion, and five as suspected vasculitis. Median time from intravitreal injection to symptoms was 10 days and 88% (n = 21) occurred after the first injection. Symptoms included reduced vision (71%), eye pain (33%), and elevated intraocular pressure (50%). All patients received corticosteroids and 29% received antibiotics. At last follow-up, six eyes recovered visual acuity to within one line of baseline, seven lost between 2 to 5 lines, and 11 lost 6 lines or more.

While IOI and vasculitis are rare, patients can be educated to call a retina specialist promptly if symptoms or any vision loss develop, especially within the 2 weeks following the first injection. In addition to excluding an infectious etiology, individualized management with multiroute corticosteroids can be considered.