Intravitreal Pegcetacoplan for Age-Related Macular Degeneration Linked to "Floaters" Due to Silicone Oil Droplets

Intravitreal pegcetacoplan (Syfovre) injections, recently approved for dry age-related macular degeneration, linked to "floaters." These floaters result from presumed intravitreal silicone oil droplets. This association was discovered in a retrospective record review from a retinal health clinic. This study was published in JAMA Ophthalmology.

In a study conducted by Dr. Amr Dessouki and colleagues at the Retinal Diagnostic Center in California, 16 out of 55 patients treated with intravitreal pegcetacoplan developed presumed intravitreal silicone droplets 2 to 4 weeks after treatment. Among these patients, 14 experienced new floaters that were described as persistent, while two were asymptomatic. No patients showed signs of inflammation, infection, or a decline in visual acuity.

Floaters can be bothersome and may require surgical treatment to address. Although they are not debilitating, they can be an annoyance to patients. This is not the first instance of silicone oil droplets appearing following intravitreal injections. Similar reports were made in 2017 after the use of intravitreal bevacizumab (Avastin), a drug used to treat wet age-related macular degeneration.

A 2018 survey of American retinal surgeons found that 5% of respondents had performed vitrectomy surgery for symptomatic silicone oil, and 2% had patients who sought legal action. Intravitreal pegcetacoplan was approved by the FDA earlier this year for the treatment of geographic atrophy associated with nonexudative age-related macular degeneration. While it does not reverse vision loss, it slows down further deterioration.

In this study, researchers suspect that the medication is interacting with the syringe during administration, resulting in the formation of oil droplets. This interaction may occur when the syringe is used to remove air bubbles. Silicone oil is used to lubricate the inner wall of the syringe, which can contribute to the problem.

To address this issue, researchers suggest using silicone-free syringes, although these are difficult to find. Another solution could involve prepacking the medication in syringes to minimise the need for pushing and pulling, which generates oil droplets.

Intravitreal pegcetacoplan injections, a promising treatment for age-related macular degeneration, have been associated with the development of floaters due to presumed intravitreal silicone oil droplets. The interaction between the medication and the syringe may be the primary cause of this issue. Physicians are urged to exercise caution when using this medication and to inform patients about this uncommon side effect.

Reference:

Dessouki, A., He, L., Park, K., Chen, H., & Chow, C. C. Presumed silicone oil droplets after intravitreal pegcetacoplan injections. JAMA Ophthalmology,2023. https://doi.org/10.1001/jamaophthalmol.2023.4326