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Case Reports
. 2024 Dec 2;24(1):520.
doi: 10.1186/s12886-024-03788-w.

Aflibercept high-dose (8mg) related intraocular inflammation (IOI) - a case series

Laura Hoffmann  1 , Stephan Michels  2 , Chiara Eandi  3 , Muntadher Al Karam  2 , Eva C de Oliveira Figueiredo  3 , Katja Hatz  4   5
Affiliations
Case Reports

Aflibercept high-dose (8mg) related intraocular inflammation (IOI) - a case series

Laura Hoffmann et al. BMC Ophthalmol. .

Abstract

Background: Monitoring for potential inflammatory events following intravitreal anti-vascular endothelial factor (VEGF) injection is crucial with the use of new agents such as aflibercept 8 mg. Despite a safety profile comparable to aflibercept 2 mg in pivotal and phase 3 studies, reporting such cases in clinical practice helps evaluate potential risk of these agents.

Case presentation: In this case series, a cluster of 8 patients manifesting acute intraocular inflammation (IOI) after intravitreal aflibercept 8 mg injection at three different centers are described. All patients developed inflammation of the vitreous and anterior chamber within 2-17 days following the injection. All subjects had previously received intravitreal anti-vascular endothelial growth factor (VEGF) therapy (ranibizumab, aflibercept 2 mg or faricimab) without injection-related complications. No signs of vasculitis, papillitis or retinitis were noted. In view of the clinical presentation, vitreous cultures were not performed. Inflammation resolved with topical steroids and non-steroidal anti-inflammatory drugs over a course of 11-24 days with excellent visual recovery.

Conclusions: We report a cluster of injection-related ocular inflammation following intravitreal aflibercept 8 mg with at present unknown cause. It underlines the need for clinical awareness to detect such cases despite the low-risk safety profile in pivotal studies.

Keywords: Adverse event; Aflibercept 8 mg; Anti-VEGF; High dose; Intraocular inflammation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki. Consent for publication: Written informed consent has been obtained from the patients to publish this paper. Competing interests: K.H. received fees for consultancies and advisory board participations from Novartis, Bayer, Roche, and Allergan/Abbvie. S.M. received fees for advisory boards of Bayer, Novartis and Roche and grant support from Bayer, Apellis.

Figures

Fig. 1
Fig. 1
Fluoresceine angiography and color fundus imaging at presentation showing vitritis in the absence of vasculitis (A-D). After 5 days, fundus imaging (E) showing improved vitritis after topical steroid therapy
Fig. 2
Fig. 2
Color fundus imaging of a central vitreous opacity in the absence of vasculitis or retinitis
Fig. 3
Fig. 3
Fluoresceine, indocyanine green and color fundus imaging at presentation reveal vitritis without retinal-choroidal inflammation or vitritis (A-C). After steroid treatment the vitritis resolved (D)
Fig. 4
Fig. 4
Fluoresceine angiography and fundus imaging (A, B) show mild vitritis without vasculitis or papillitis. Inflammation resolved after topical steroids (C)
Fig. 5
Fig. 5
OCT imaging shows initial regression of macular edema with a recurrence 10 weeks after aflibercept 8 mg
See this image and copyright information in PMC

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