Short-term intraocular pressure changes following intravitreal aflibercept 8 mg versus 2 mg in diabetic macular edema: a prospective observational study

This prospective observational study evaluated short-term intraocular pressure (IOP) changes and safety following intravitreal injection of aflibercept 8 mg versus 2 mg in diabetic macular edema (DME). We included 40 eyes from 36 patients with center-involving DME, with 18 patients and 20 eyes in each group. IOP was measured at baseline (sitting and supine), 30 s post-injection (supine, T1), and at 5, 15, and 30 min (sitting, T2-T4). Vitreous reflux (VR), paracentesis, and baseline data were also assessed. Both groups showed a marked but transient IOP rise, peaking at T1 (59.0 ± 17.4 mmHg and 60.1 ± 20.8 mmHg) and returning to near baseline by T4 (14.6 ± 4.6 mmHg and 16.6 ± 6.7 mmHg), without significant between-group differences. No eyes required paracentesis, and VR severity was comparable. At T1, greater VR or prior vitrectomy was associated with lower IOP, but this effect was not sustained, and other baseline factors did not significantly affect IOP. These findings suggest that aflibercept 8 mg induces a transient IOP elevation comparable to that with aflibercept 2 mg, with IOP returning to baseline levels by 30 min. Additionally, aflibercept 8 mg demonstrated an acceptable short-term safety profile in eyes with DME.