A Comparative Assessment of Intraocular Pressure Changes After Aflibercept 8 mg and Faricimab-svoa Intravitreal Injections in Wet Age-Related Macular Degeneration

Abstract

Introduction A standard practice for addressing wet age-related macular degeneration (WetAMD) is to deliver anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Formulations with higher concentrations, such as aflibercept 8 mg (Eylea HD; Bayer AG, Leverkusen, Germany), which are administered in larger volumes, may raise concerns about potential increases in intraocular pressure (IOP) and other ocular complications. The objective of this study was to evaluate and compare short-term IOP changes following intravitreal injection of aflibercept 8 mg (Eylea HD, 0.07 mL) versus faricimab-svoa (Vabysmo, 0.05 mL; Roche Pharma, Basel, Switzerland/Genentech, South San Francisco, CA, USA) in patients with WetAMD. Methods A retrospective observational analysis was conducted involving patients with WetAMD who received intravitreal injections of aflibercept 8 mg (n = 64 eyes) or faricimab-svoa (n = 73 eyes). IOP was measured before the injection and 30 minutes after. The research recorded lens condition, the need for paracentesis, and the application of Iopidine drops. Patients were categorized into phakic and pseudophakic subgroups, and further stratified based on post-injection IOP levels: <20 mmHg, 20-25 mmHg, 25-30 mmHg, and >30 mmHg. Results Both treatment groups showed notable increases in IOP at 30 minutes after injection (Eylea HD: +4.50 ± 4.32 mmHg, Vabysmo: +3.66 ± 5.20 mmHg; p = 0.083). However, there were no instances requiring paracentesis, and only one patient from each group needed Iopidine drops. Pseudophakic patients experienced slightly higher IOP increases (Eylea HD: +4.71 ± 4.18 mmHg, Vabysmo: +4.55 ± 5.65 mmHg; p = 0.784) compared to phakic patients. The majority of patients maintained IOP levels under 30 mmHg. Gender distribution was 49% male and 51% female. Conclusions Intravitreal injections of aflibercept 8 mg and faricimab-svoa caused a small and temporary increase in IOP and there were no cases requiring urgent management. Our results confirm the short-term ocular safety of aflibercept 8 mg and faricimab-svoa for the treatment of WetAMD and highlight the need for individualized monitoring for patients at risk of increased IOP.

Keywords: aflibercept 8mg intravitreal injection; anti-vegf treatment; faricimab intravitreal injection; intraocular pressure (iop); wet-aged related macular degeneration.

Figure 1. IOP changes by drug

Boxplot of IOP changes by drug. This visualizes the distribution and range of IOP change from baseline to 30 minutes post-injection for Eylea 8 mg vs. Vabysmo. The error bars in this boxplot are the whiskers, which typically represent the range within 1.5 × IQR (interquartile range) from the first (Q1) and third (Q3) quartiles. Outliers beyond this range are shown as individual points. The box itself spans Q1 to Q3, with a horizontal line at the median. IOP, intraocular pressure

Figure 2. Distribution of patients by post-injection IOP category for each drug

Countplot showing the distribution of patients by IOP category (<20, 20-25, 25-30, >30 mmHg), post-injection, for each drug. IOP, intraocular pressure

Figure 3. Mean IOP change by lens status across drug groups

Bar plot representing mean IOP change based on lens status (phakic vs. pseudophakic) across both drug groups. The vertical error bars in this bar plot represent the standard deviation (SD) of the IOP change within each group, defined by lens status and drug. IOP, intraocular pressure