Appendix
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Ophthalmology

Aflibercept

Aflibercept is an anti-vascular endothelial growth factor (VEGF) medication approved for the treatment and management of neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema, macular edema secondary to retinal vein occlusion, diabetic retinopathy, and retinopathy of prematurity. Aflibercept is a humanized recombinant fusion protein that functions as a soluble decoy for VEGF receptors, also known as "VEGF trap," which is designed to inhibit the predominant signaling p

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Patients and caregivers should be instructed to promptly report any clinical signs and symptoms suggestive of retinal detachment, endophthalmitis, or retinal vasculitis.
  • These symptoms may include ocular pain, increased discomfort, eye redness, blurred vision, increased sensitivity to light, or an increased number of floaters.
  • Risk of thrombosis : A study found that IVT aflibercept is associated with a higher risk of arterial thromboembolic events (ATEs), especially in patients with a recent history of acute myocardial infarction, ischemic stroke, or coronary artery disease.
  • The risk is significantly elevated when an acute myocardial infarction or ischemic stroke occurs within 6 months before injection.
  • Clinical technicians also perform imaging studies such as optical coherence tomography (OCT) and fundus photography.
  • OCT provides cross-sectional images of the retina, allowing assessment of individual layers, evaluation of disease progression, and measurement of treatment response.
  • The central retinal arteriolar equivalent (CRAE), a measure of arteriolar width, is elevated in aggressive ROP and correlates with disease severity and reactivation risk.
  • Aflibercept is an anti-vascular endothelial growth factor (VEGF) medication approved for the treatment and management of neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema, macular edema secondary to retinal vein occlusion, diabetic retinopathy, and retinopathy of prematurity.
  • The American Academy of Ophthalmology (AAO) 2025 guidelines recommend intravitreal (IVT) aflibercept for the treatment of nAMD with CNV.
  • Clinicians should maintain strict aseptic technique when delivering any IVT injection.
  • IVT aflibercept is contraindicated in patients with ocular or periocular infections, active ocular inflammation, or a known hypersensitivity to aflibercept or any excipients found in the formulation.
  • Use of IVT aflibercept should be avoided in patients with ongoing ocular infections, those who have recently undergone ocular surgery, or individuals with elevated IOP.
  • Aflibercept should only be administered during pregnancy if the potential benefits outweigh the risks to the fetus.
  • Aflibercept is not recommended during breastfeeding according to the FDA-approved product labeling.
  • Off-label ocular uses of aflibercept include treatment of myopic CNV, polypoidal choroidal vasculopathy, macular edema secondary to radiation retinopathy, and idiopathic CNV.
  • Women of reproductive potential should use effective contraception before initiating treatment, throughout the duration of therapy, and for at least 3 months following the final IVT injection of aflibercept.
  • Following aflibercept administration, patient self-monitoring is essential to detect early signs of infection, pain, and/or decreased visual acuity.
  • Patients should be instructed on using the Amsler grid to monitor the potential reactivation of nAMD.
  • IOP should be monitored both before and after each IVT injection of aflibercept.
  • The AAO recommends that patients return for a follow-up examination approximately 4 weeks after the initial treatment.
  • Subsequent follow-up and treatment will depend on the clinical findings and the ophthalmologist's judgment.
  • Monocular near vision, including reading and Amsler grid assessments, should be monitored accordingly.
  • Single reports indicate that IVT aflibercept can cross the blood-retina barrier, potentially contributing to vascular events such as thromboembolism, heart attack, stroke, and even death.
  • review
    Aflibercept. StatPearls [Internet] — Basil Suresh, Preeti Patel — StatPearls Publishing, 2025

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov