Pegcetacoplan Associated Exudation

A patient presented with gradually decreased vision in her both eyes for several years. She had a history of multiple intravitreal aflibercept injections in her both eyes, with the last one administered 3 years ago. Her exam was notable for visual acuity of 20/50 in the right eye and 20/150 in the left eye. Fundus examination revealed macular drusen with patches of geographic atrophy in both eyes. Optical coherence tomography (OCT) of both eyes showed sub-foveal complete retinal pigment epithelium (RPE) and outer retinal atrophy without intra retinal or subretinal fluid (IRF/SRF) in both eyes. Macular neovascularization (MNV) was not detected using swept-source OCT angiography (SS-OCTA). She was recommended to receive monthly intravitreal pegcetacoplan (IVP) injections in both eyes. Follow up macular OCT of her left eye at month 8 revealed IRF without any new visual symptoms. Evaluation showed no signs of inflammation, vascular abnormality, or MNV. She continued with IVP. However, she developed symptoms with increased macular exudation at month 9. She received intravitreal aflibercept, resulting in significant improvement of edema after a week, coinciding with her monthly dose of IVP. Three weeks after IVP, edema increased again. At this point, she was observed without any injection. Significant improvement of exudation was noted 6 weeks after the last IVP. The exudation decreased with increased intervals between IVP injections. She was recommended to receive IVP every 8 weeks without additional anti-VEGF therapy.

Presentation Date: 05/16/2024

Issue Date: 05/24/2024