Non-infectious occlusive retinal vasculitis following switching from aflibercept 2 mg to aflibercept 8 mg in neovascular age-related macular degeneration: a case report

BACKGROUND: Anti-vascular endothelial growth factor (anti-VEGF) therapy represents the standard of care for neovascular age-related macular degeneration (nAMD). Aflibercept 8 mg was recently introduced with extended dosing intervals and favorable safety outcomes in phase III trials. Although no confirmed cases of occlusive retinal vasculitis were reported in pivotal studies, rare inflammatory vascular events may emerge during broader real-world exposure. CASE PRESENTATION: A 74-year-old pseudophakic male with active nAMD in the left eye demonstrated significant anatomical and functional improvement following intravitreal aflibercept 2 mg. After switching to aflibercept 8 mg, the patient presented 26 days later with painful visual deterioration. Fundus examination revealed mild vitritis, segmental arterial sheathing, venous narrowing, and peripheral intraretinal hemorrhages. Fluorescein angiography demonstrated capillary non-perfusion and late vascular leakage. Optical coherence tomography confirmed cystoid macular edema. Extensive infectious and autoimmune investigations were negative. Systemic and local corticosteroid therapy resulted in regression of inflammation with partial visual recovery. CONCLUSIONS: Non-infectious occlusive retinal vasculitis may rarely occur following switching to aflibercept 8 mg. Early recognition and prompt anti-inflammatory treatment are critical to minimize irreversible ischemic damage. Continued post-marketing pharmacovigilance is warranted.