Pegcetacoplan injections for geographic atrophy associated with silicone oil drops in vitreous cavity

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The use of silicone-free syringes advised with these drops.

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(Image Credit: ©Tan - Adobe.Stock.com)

Silicone oil droplets appearing in the vitreous cavity may be associated with intravitreal injection of pegcetacoplan (Syfovre, Apellis Pharmaceuticals) as a result of the type of syringe used to inject the drug,1 according to Amr Dessouki, MD, and colleagues from the Retinal Diagnostic Center, Campbell, CA.

Pegcetacoplan is the first drug approved by the FDA to treat geographic atrophy associated with nonexudative age-related macular degeneration.

Medical record review of pegcetacoplan injections

The authors conducted a retrospective case series study to determine the prevalence of the presumed silicone oil droplets in the vitreous cavities of patients who were treated with an intravitreal injection of pegcetacoplan. The drug was administered via McKesson 1-mL Luer lock syringes that the manufacturer supplied.

The authors reviewed the medical records of 55 patients who received intravitreal pegcetacoplan, 0.1 mL in 150-mg/mL solution, between March 24 and June 5, 2023, in 1 retinal practice.

The main outcomes, according to the investigators, were the presence or absence of presumed silicone bubbles detected during dilated biomicroscopic fundus examination and/or on color fundus photographs, the presence or absence of symptoms, changes in the visual acuity, and/or increases in intraocular pressure.

The study found that the 55 patients received a total of 62 intravitreal pegcetacoplan injections.

Of the 55 patients, 16 patients (29%) (mean age, 83.8 years) had presumed intravitreal silicone droplets in the vitreous cavity. The drops were identified from 2 to 4 weeks following the injections. The drops were seen on color fundus photographs from 3 patients.

Fourteen (88%) of the 16 affected patients were symptomatic for new floaters, which they described as persistent, and the other 2 (13%) patients were asymptomatic. The investigators did not observe inflammation or infection, increases in intraocular pressure, or any changes in the visual acuity in the 16 affected patients.

The authors concluded, “A substantial percentage of patients had symptomatic floaters from presumed intravitreal silicone oil droplets after injections of pegcetacoplan using a McKesson 1-mL Luer lock syringe. These findings support consideration of informing patients of this potential adverse effect, avoiding use of the McKesson syringe, and considering use of silicone-free syringes for pegcetacoplan injections.”

Reference:
Dessouki A, He L, Park K, et al. Presumed silicone oil droplets after intravitreal pegcetacoplan injections. JAMA Ophthalmol. 2023;Published online October 5; doi:10.1001/jamaophthalmol.2023.4326

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