Pegcetacoplan Therapy Induced Optic Nerve Head Edema
Section outline
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A patient presents to clinic after 1 year of monthly pegcetacoplan dosing incidentally found to have Optic Nerve Head Edema of the Left Eye on 12x 12mm scans with Swept Source OCT-angiography imaging. A full neuro-ophthalmologic review was performed including MRI imaging which was unremarkable as well as stable vision throughout this course. Oct-nerve and HVF testing was also performed which showed no pattern recognizably related to known findings in papilledema or ischemic optic neuropathy. Patient was placed on oral prednisone with no resolution of nerve edema and then slowly switching over to daily acetazolamide 500mg daily. This was continued for over 18 months along with complete cessation of Pegcetacoplan Injections. Serial OCTA images were taken, demonstrating gradual resolution of optic nerve head nearly back to baseline more than 1.5 years later. Given the constellation of findings along with lack of vision decrease, systemic findings and classical findings of above pathology, the current findings were elucidated to be likely due to induced edema from Pegcetacoplan therapy. The patient was eventually taken off oral acetazolamide and decision was made to challenge the patient again with Pegcetacoplan. This was one of the first documented observations of a subclinical level of optic nerve and retinal edema after serial Pegcetacoplan intravitreal therapy however preliminary data has shown about a 2-3% rate of optic nerve thickening especially in patient with baseline crowded disc. More data collection and analysis with longer follow-up will be needed to determine safety threshold and any possible clinical complications of this observation.
Presentation Date: 02/12/2026
Issue Date: 03/20/2026
