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

Purpose: To 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. Methods: This 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. Results: A 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. Conclusions: Intravitreal 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.