Ophthalmic Surg Lasers Imaging Retina. 2026 Aug;57(8):492-498. doi: 10.3928/23258160-20260521-03.
Summary
Post-Syfovre IOI + vasculitis 24 eyes (22 patients, 306,000 injections between 3-1-23 and 8-31-24). Median 10 days post-injection. 88% after 1st injection — Retrospective, Apellis, All reported cases.
Abstract
Background and objective: This expert opinion review is intended to provide guidelines for diagnosis and management of intraocular inflammation (IOI) and vasculitis following pegcetacoplan.
Patients and methods: A case series of all post-marketing reports classified by experts as definite or suspected vasculitis over an 18-month period was assessed.
Results: 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.
Conclusion: 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.
