A Comparative Assessment of Intraocular Pressure Changes After Aflibercept 8 mg and Faricimab-svoa Intravitreal...

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.