Short-Term Intraocular Pressure Changes After Intravitreal Aflibercept 8 mg via Prefilled Syringe

INTRODUCTION: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is a standard treatment for neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO). A transient rise in intraocular pressure (IOP) following injection is a well-established short-term effect. Aflibercept 8 mg has recently been introduced in a prefilled syringe (PFS), although data on its short-term effect on IOP are still lacking. The aim of this study was to assess short-term IOP changes after intravitreal aflibercept 8 mg administered via PFS and to compare these results with historical cohorts receiving aflibercept 8 mg via standard syringe and aflibercept 2 mg via PFS. METHODS: This single-centre comparative observational cohort study included a prospectively enrolled cohort of patients with nAMD or DMO receiving aflibercept 8 mg via PFS (0.07 mL), while two retrospective historical cohorts receiving aflibercept 8 mg via standard syringe (0.07 mL) or aflibercept 2 mg via PFS (0.05 mL) were used for comparison. IOP was measured with the iCare IC200 rebound tonometer at baseline (T0), 30 s (T1), 5 min (T2), and 15 min (T3) post-injection. Patients with glaucoma or ocular hypertension were excluded. Statistical analysis was performed using Friedman and Kruskal-Wallis tests. RESULTS: Forty-six eyes treated with aflibercept 8 mg PFS were analysed. Baseline IOP was similar across the three groups (p = 0.54). In the aflibercept 8 mg PFS cohort, mean IOP increased from 13.92 ± 4.25 mmHg at baseline to 51.29 ± 15.07 mmHg at 30 s, then fell to 31.32 ± 12.24 mmHg at 5 min and to 20.25 ± 7.08 mmHg at 15 min (p < 0.001). No statistically significant between-group differences were detected at any timepoint (all p ≥ 0.18). CONCLUSION: Intravitreal aflibercept 8 mg administered via PFS was associated with a transient rise in IOP immediately after injection, which resolved within 15 min and was similar to that observed with aflibercept 2 mg via PFS and aflibercept 8 mg via standard syringe. These findings contribute to the characterization of the short-term IOP response associated with aflibercept 8 mg PFS administration and may help inform routine clinical practice.