Aflibercept

Aflibercept is administered by an ophthalmologist or trained retinal specialist as an intravitreal injection — meaning it is injected directly into the vitreous cavity of the eye using a very fine needle. Before the injection, the eye is numbed with topical or local anesthetic drops, and the surface of the eye is cleaned with an antiseptic solution (typically povidone-iodine) to minimize the risk of infection. The procedure itself takes only a few seconds. Patients may feel a sensation of pressure but usually minimal pain. After the injection, your doctor will check intraocular pressure and examine the eye. Most patients notice floaters or brief blurred vision immediately after the injection, which typically resolves within hours. You should arrange transportation home since your vision may be temporarily affected.

The most common side effects are related to the injection itself and include conjunctival hemorrhage (a red spot on the white of the eye), eye pain, floaters, and a temporary increase in eye pressure. These are usually minor and resolve on their own. However, there are serious side effects that require immediate medical attention. Endophthalmitis — a severe infection inside the eye — is a rare but potentially vision-threatening complication. Warning signs include increasing eye pain, redness, sensitivity to light, and worsening vision in the days after an injection. Retinal detachment is another serious risk. Systemically, aflibercept carries a low but real risk of arterial thromboembolic events, including heart attack or stroke, due to systemic VEGF inhibition. Patients with prior cardiovascular disease should discuss this risk of side effects carefully with their healthcare professional before starting treatment.

The injection frequency depends on your specific condition. For neovascular AMD, the standard regimen starts with monthly injections for three months (loading phase), followed by injections every 8 weeks. After the first year, many patients can be extended to every 12 weeks. For diabetic macular edema, the loading phase involves 5 monthly injections, then every 8 weeks. Your ophthalmologist will assess your disease activity at each visit using optical coherence tomography (OCT) imaging and may adjust the interval based on how your retina responds. Many patients require ongoing treatment to maintain visual gains, as the underlying disease continues. Stopping injections prematurely often leads to recurrence of fluid and potential vision loss.

This is an important question to discuss thoroughly with your healthcare professional. While the amount of aflibercept that enters the bloodstream after an eye injection is very low, VEGF plays a role in maintaining blood vessel health throughout the body. Systemic VEGF inhibition — even at low levels — has been associated with a small increased risk of arterial thromboembolic events, including nonfatal heart attack or stroke. If you have uncontrolled blood pressure, have recently experienced a heart attack or stroke, or have significant cardiovascular disease, your ophthalmologist will weigh the vision-saving benefits of treatment against this cardiovascular risk. In many cases, the benefit of preserving vision outweighs the small systemic risk, but it requires individualized discussion.

Aflibercept is not recommended during pregnancy. VEGF signaling is essential for normal vascular development of the fetus, and blocking it could cause fetal harm. Animal studies have shown reproductive toxicity. Women of childbearing potential should use effective contraception during aflibercept treatment and for at least 3 months after the last dose. If you are pregnant, planning to become pregnant, or currently breastfeeding, talk to your doctor before making any medication decisions.