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Effect of Intravitreal Complement Inhibitor on Ganglion Cell Complex Over Time
Presenter:
Sarah Guo
Authors:
Sarah Guo, MD; Austin Cho, MD; Natalie Chen, MD; Andrew Browne, MD PhD; Jack Benjamin Margines, MD
Gavin Herbert Eye Institute University of California, Irvine
Affiliation:
Purpose: To evaluate effect of intravitreal complement inhibitor on ganglion cell complex. With the advent of intravitreal complement inhibitor that was FDA approved in 2023, there is now a treatment to prevent progression of advanced dry macular degeneration. Prior studies have evaluated ganglion cell complex (GCC) thinning over time with anti-VEGF treatment for wet macular degeneration or diabetic retinopathy with varied results. Among the studies that demonstrated thinning, they attribute such changes to age, RPE atrophy, intraocular pressure spikes associated with injection volume, and Anti-VEGF toxicity to retinal ganglion cells. Intravitreal complement inhibitor has a higher volume injection than tranditional anti-VEGF treatments. No study to date has evaluated changes in GCC in relation to intravitreal complement inhibitor use.
Methods: We retrospectively evaluated 20 eyes of 15 patients who were diagnosed with advanced dry macular degeneration and were treated with at least 6 intravitreal injections of Pegcetocoplan or Avacincaptad pegol at the University of California Irvine between September 2023 and October 2025. We collected demographics (age, sex, ethnicity), ganglion cell thickness values from each of 6 quadrants, the minimum, and average thickness at treatment initiation and after at least 6 injections. Only GCC with good segmentation as determined by a physician grader were analyzed. Descriptive statistics were used for demographic information and a student’s t-test was used to evaluate for differences before and after treatment.
Results: Over the course of treatment, there was no significant change in average or minimum GCC. Average age was 82 years with 37.5% being male. Fifty percent were Caucasian, 12.5% were Asian/Pacific Islander, 6.25% were Hispanic, and the rest were unknown demographic. Average GCC pre-treatment was 62.85 and 61.1 post treatment. On average, patients received 9.5 injections (6-18). The superotemporal quadrant GCC changed from 61.5 to 63.75 (p>0.05), superior from 58.95 to 60.25 (p>0.05), superonasal 63.5 to 66.15 (p>0.05), inferotemporal 65.2 to 71.35(p=0.04), inferior from 61.05 to 59.4, inferonasal from 67.4 to 64.85)).
Conclusion: Intravitreal complement inhibitor is not associated with progressive ganglion cell thinning over time.