Fellow-eye effect of intravitreal aflibercept 8mg in a patient with bilateral refractory nAMD: a case report and literature review

BACKGROUND: Intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy remains first-line therapy for the treatment of neovascular age-related macular degeneration (nAMD), but the high frequency of injections imposes a substantial burden on elderly patients. High-dose aflibercept 8 mg has been shown to extend dosing intervals while maintaining anatomical control. Fellow-eye effects have been reported with other anti-VEGF agents but not with aflibercept 8 mg. CASE PRESENTATION: An 89-year-old woman with bilateral refractory nAMD had received 23 prior anti-VEGF injections in the right eye. Owing to financial constraints, she underwent unilateral aflibercept 8 mg injection in the right eye only. Baseline best-corrected visual acuity (BCVA) was 0.82 the logarithm of the minimum angle of resolution (logMAR) in the right eye and 1.0 logMAR in the left eye. One week after intravitreal injection, optical coherence tomography (OCT) showed marked bilateral improvement: central subfield thickness (CST) decreased from 629 to 327 μm in the treated eye and from 357 to 308 μm in the untreated fellow eye. BCVA remained stable in the treated eye, while improved to 0.70 logMAR in the fellow eye. CONCLUSION: This is the first reported case of a fellow-eye effect associated with aflibercept 8 mg. The findings suggest a potential systemic effect of high-dose aflibercept, but it should be noted that, for patients with bilateral nAMD, bilateral treatment is still necessary to avoid insufficient treatment of the contralateral eye.