Nonarteritic Anterior Ischemic Optic Neuropathy Associated With Retinal Nerve Fiber Layer Thickening Following Intravitreal Pegcetacoplan Therapy

Purpose: To characterize the clinical course of 3 cases of nonarteritic anterior ischemic optic neuropathy during treatment of geographic atrophy with pegcetacoplan. Methods: This retrospective case series includes longitudinal analysis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained by spectral-domain optical coherence tomography (OCT). Automatically generated RNFL scans were manually re-segmented when necessary. Results: Three patients developed nonarteritic anterior ischemic optic neuropathy after receiving 6 to 11 pegcetacoplan injections administered every 6 to 8 weeks. One patient was asymptomatic, and the diagnosis was made only through routine optic nerve monitoring. In all eyes, RNFL thickness increased gradually before the onset of nonarteritic anterior ischemic optic neuropathy, at a greater rate in affected eyes than in fellow eyes. Conclusions: Peripapillary RNFL thickness measured by OCT may be useful for monitoring patients receiving pegcetacoplan therapy and may allow earlier detection of nonarteritic anterior ischemic optic neuropathy. Changes in RNFL thickness may precede the development of nonarteritic anterior ischemic optic neuropathy.