Izervay (avacincaptad pegol) is an eye injection used to slow the progression of geographic atrophy, an advanced form of dry age-related macular degeneration. The most common side effects are conjunctival hemorrhage (13% of patients at 12 months), increased eye pressure (9%), and blurred vision (8%). Most of these are mild and related to the injection itself, but there is one notable risk that sets Izervay apart: an increased chance of developing wet AMD.
Common Side Effects
In the two major clinical trials (GATHER1 and GATHER2), researchers tracked side effects in nearly 300 patients receiving Izervay and compared them to a control group. At 12 months, the most frequently reported reactions were:
- Conjunctival hemorrhage: 13% with Izervay vs. 9% with sham. This is a small bleed on the white of the eye, typically painless and cosmetic.
- Increased eye pressure: 9% vs. 1%. Often a temporary spike right after the injection.
- Blurred vision: 8% vs. 5%. This can include temporarily reduced visual sharpness.
- Eye pain: 4% vs. 3%.
- Vitreous floaters: 2% vs. less than 1%. Small spots or threads drifting across your field of vision.
- Eyelid inflammation (blepharitis): 2% vs. less than 1%.
Over 24 months in the GATHER2 trial, these rates climbed somewhat. Blurred vision increased to 14%, conjunctival hemorrhage to 17%, and increased eye pressure to 13%. Additional side effects that appeared at the two-year mark included tiny scratches on the cornea (punctate keratitis, 10%), retinal hemorrhage (4%), and corneal abrasion (2%).
Risk of Developing Wet AMD
This is the side effect that gets the most attention. Izervay works by blocking a part of the immune system called complement, which is involved in the damage that causes geographic atrophy. But this same treatment appears to increase the risk that dry AMD converts to wet AMD, a condition where abnormal blood vessels grow under the retina and leak fluid.
At 12 months across both trials, 7% of patients on Izervay developed wet AMD compared to 4% in the control group. By 24 months in GATHER2, that gap narrowed slightly: 12% on Izervay vs. 9% on sham. In the GATHER1 trial alone, the difference was starker at 18 months, with nearly 12% of treated patients converting compared to under 3% in the control group.
Real-world data from a study of 461 eyes painted a slightly different picture. About 2% of treated eyes converted to wet AMD, though those patients had received only a few injections on average. The researchers calculated an annualized conversion rate of roughly 6%. If you’re being treated with Izervay, your eye doctor will monitor you for signs of wet AMD at each visit, since catching it early allows for effective treatment with anti-VEGF injections.
Pressure Spikes After Injection
A temporary jump in eye pressure right after the injection is one of the most predictable side effects. The FDA label notes that transient increases in intraocular pressure have been observed with Izervay. In clinical trials, 9% of patients experienced this at 12 months and 13% by 24 months, compared to just 1% in control groups. An additional 4% of patients at two years had elevated eye pressure classified separately as ocular hypertension.
Real-world data from 461 eyes found that about 3% experienced an acute pressure spike severe enough to temporarily cause a complete loss of light perception. In most of those cases, vision recovered on its own. A small number required a procedure to drain fluid and relieve the pressure. Your eye care provider will typically check your pressure after the injection before you leave the office.
Rare but Serious Risks
Some serious complications are possible with any intravitreal injection, not just Izervay specifically. These include endophthalmitis (a severe infection inside the eye), retinal detachment, and vitreous hemorrhage (bleeding inside the eye). In the GATHER trials, 1% or fewer patients experienced these events over 24 months. The two-year trial data showed no cases of retinal vasculitis, ischemic optic neuropathy, or serious intraocular inflammation.
In the real-world study, one eye developed vitreous hemorrhage, but there were no cases of endophthalmitis or intraocular inflammation. Retinal detachment from intravitreal injections generally is extremely rare, occurring in roughly 1 out of every 7,500 injections across all types of eye injections.
Side Effects From the Injection Itself
Some side effects have nothing to do with the drug and everything to do with having a needle inserted into your eye. Conjunctival hemorrhage, the most common side effect in the trials, is a classic example. It’s a small surface bruise that looks alarming but resolves on its own, usually within a week or two. Corneal abrasions, mild eye pain, and floaters also fall into this category.
During the injection, the needle passes through the outer wall of the eye and into the gel-like interior. Occasionally this can nick the lens capsule (potentially causing a cataract over time) or, very rarely, the retina. These injection-related complications are the same regardless of which medication is being injected and are one reason these procedures are performed by trained ophthalmologists in a sterile setting.
Who Should Not Receive Izervay
Izervay is contraindicated if you have an active infection in or around the eye, or if you have active inflammation inside the eye. Your doctor will examine your eye before each injection and may postpone treatment if either condition is present. There are no boxed warnings on the FDA label, which means the agency did not identify a safety concern severe enough to warrant the highest level of alert.