Early intraocular pressure dynamics following aflibercept 8 mg versus aflibercept 2 mg: a propensity score-matched analysis.

purposeTo compare early intraocular pressure (IOP) dynamics following intravitreal injections of aflibercept 8 mg versus aflibercept 2 mg using propensity score-matched analysis with fellow eye controls.

methodsThis prospective observational study included treatment-naïve patients with neovascular age-related macular degeneration (AMD) or diabetic macular oedema (DMO). Patients received aflibercept 8 mg or 2 mg based on investigator discretion. IOP was measured using iCare rebound tonometry at baseline (T0), 1 min (T1), 10 min (T2), 30 min (T3), and 3 months (T4) after the initial treatment. Untreated fellow eyes served as controls. Secondary analyses evaluated predictors of significant IOP elevation.

resultsA total of 1820 IOP measurements from 140 eyes (35 treated with aflibercept 8 mg and 35 with aflibercept 2 mg and their respective untreated fellow eyes) were analysed. Both formulations induced significant immediate IOP elevations at T1 (55.6 ± 15.2 mmHg for 8 mg, 54.2 ± 20.4 mmHg for 2 mg) compared to baseline values (p < 0.001). Pressures decreased progressively, approaching baseline by T3 (19.3 ± 5.9 mmHg for 8 mg, 20.5 ± 6.6 mmHg for 2 mg), with no significant differences between doses (p > 0.05). Pre-existing glaucoma emerged as the strongest predictor of sustained IOP elevation, while DMO eyes exhibited higher initial spikes compared to neovascular AMD. Three-month IOP remained stable across both groups.

conclusionsIntravitreal administration of aflibercept 8 mg demonstrates IOP dynamics comparable to the 2 mg formulation, with rapid normalization of pressure spikes by 30 min. These findings suggest enhanced monitoring may be beneficial for patients with glaucoma or DMO.