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Anti-VEGF agent (intravitreal) Pregnancy: §4.6: Women of childbearing potential 'have to use effective contraception during treatment and for at least 3 months after the last intravitreal injection of aflibercept'. Pregnancy — 'There are no data on the use of aflibercept in pregnant women. Studies in animals have shown embryo-foetal toxicity… Although the systemic exposure after ocular administration is very low, Afqlir should not be used during pregnancy unless the potential benefit outweighs the potential risk to the foetus.' Breast-feeding — 'Based on very limited human data, aflibercept may be excreted in human milk at low levels… As a precautionary measure, breast-feeding is not recommended during the use of Afqlir.' Fertility — 'Results from animal studies with high systemic exposure indicate that aflibercept can impair male and female fertility… Such effects are not expected after ocular administration with very low systemic exposure.'

Aflibercept 2mg/0.05mL Intravitreal Injection (Eylea)

Brand names: Eylea

Aflibercept is an intravitreal anti-VEGF agent (a recombinant fusion protein) used for neovascular (wet) age-related macular degeneration, diabetic macular oedema, diabetic retinopathy and retinal vein occlusion.

Adult dose

Dose: 2 mg aflibercept (equivalent to 0.05 mL)
Route: Intravitreal injection — 'Afqlir is for intravitreal injection only' and 'must only be administered by a qualified healthcare professional experienced in administering intravitreal injections' (§4.2)
Frequency: Wet AMD: 'treatment is initiated with one injection per month for three consecutive doses. The treatment interval is then extended to two months.' Thereafter 'the treatment interval may be maintained at two months or further extended using a treat-and-extend dosing regimen, where injection intervals are increased in 2- or 4-weekly increments… If visual and/or anatomic outcomes deteriorate, the treatment interval should be shortened accordingly.'
Max: 2 mg (0.05 mL) per injection per eye — the pre-filled syringe 'contains more than the recommended dose of 2 mg aflibercept (equivalent to 0.05 ml solution for injection)… The excess volume must be expelled before injecting the recommended dose… Injecting the entire volume of the pre-filled syringe could result in overdose.'
SCOPE: the dose and frequency published above are the WET AMD regimen — the first indication listed on this page and the licence the page is built around. The same 2 mg / 0.05 mL dose is used for every indication in this SPC, but the SCHEDULES differ and are quoted here rather than in the frequency field: (i) Macular oedema secondary to RVO (branch or central) — 'The recommended dose… is 2 mg aflibercept equivalent to 0.05 ml. After the initial injection, treatment is given monthly. The interval between two doses should not be shorter than one month… Monthly treatment continues until maximum visual acuity is achieved and/or there are no signs of disease activity. Three or more consecutive, monthly injections may be needed', then a treat-and-extend regimen; (ii) Diabetic macular oedema — 'treatment is initiated with one injection per month for five consecutive doses, followed by one injection every two months', then intervals 'usually increased by 2-week increments'; 'There are limited data for treatment intervals longer than 4 months'; (iii) Myopic choroidal neovascularisation — 'a single intravitreal injection of 2 mg aflibercept equivalent to 0.05 ml. Additional doses may be administered if visual and/or anatomic outcomes indicate that the disease persists… The interval between two doses should not be shorter than one month.' For wet AMD the SPC adds 'Treatment intervals greater than four months or shorter than 4 weeks between injections have not been studied' and 'There is no requirement for monitoring between injections.' ADMINISTRATION (§4.2): aseptic technique with 'topical broad-spectrum microbicide (e.g. povidone iodine applied to the periocular skin, eyelid and ocular surface)', sterile gloves, drape and eyelid speculum; 'The injection needle should be inserted 3.5-4.0 mm posterior to the limbus into the vitreous cavity, avoiding the horizontal meridian and aiming towards the centre of the globe'; 'a different scleral site should be used for subsequent injections'. 'Each pre-filled syringe should only be used for the treatment of a single eye.' 'After injection any unused product must be discarded.' Elderly: 'No special considerations are needed. There is limited experience in patients older than 75 years with DME.' §4.4: 'do not inject… while the intraocular pressure is ≥ 30 mmHg' in poorly controlled glaucoma; bilateral same-day treatment — 'The safety and efficacy of aflibercept therapy administered to both eyes concurrently have not been systematically studied' and 'could lead to an increased systemic exposure'; 'There is no data available on the concomitant use of aflibercept with other anti-VEGF medicinal products (systemic or ocular).'

Dose adjustments

Renal

§4.2 Special populations: 'No specific studies in patients with hepatic and/or renal impairment have been conducted with aflibercept. Available data do not suggest a need for a dose adjustment with aflibercept in these patients (see section 5.2).'

Hepatic

§4.2 Special populations: 'No specific studies in patients with hepatic and/or renal impairment have been conducted with aflibercept. Available data do not suggest a need for a dose adjustment with aflibercept in these patients (see section 5.2).'

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance aflibercept or to any of the excipients listed in section 6.1 (§4.3)
  • Active or suspected ocular or periocular infection (§4.3)
  • Active severe intraocular inflammation (§4.3)
  • Do not inject while the intraocular pressure is ≥ 30 mmHg — §4.4: 'Special precaution is needed in patients with poorly controlled glaucoma (do not inject Afqlir while the intraocular pressure is ≥ 30 mmHg)'

Side effects

  • Very common / most frequent (§4.8, in at least 5% of patients treated with aflibercept): 'conjunctival haemorrhage (25%), retinal haemorrhage (11%), visual acuity reduced (11%), eye pain (10%), cataract (8%), intraocular pressure increased (8%), vitreous detachment (7%), and vitreous floaters (7%)'
  • Serious injection-procedure reactions (§4.8): 'Serious ocular adverse reactions in the study eye related to the injection procedure have occurred in less than 1 in 1 900 intravitreal injections with aflibercept and included blindness, endophthalmitis, retinal detachment, cataract traumatic, cataract, vitreous haemorrhage, vitreous detachment, and intraocular pressure increased'
  • Immune system disorders — uncommon: hypersensitivity (§4.8 Table 1)
  • Injection-related events listed in §4.4: 'endophthalmitis, intraocular inflammation, rhegmatogenous retinal detachment, retinal tear and iatrogenic traumatic cataract'
  • Raised intraocular pressure: §4.4: 'Increases in intraocular pressure have been seen within 60 minutes of intravitreal injection'
  • Systemic (§4.4): 'Systemic adverse events including non-ocular haemorrhages and arterial thromboembolic events have been reported following intravitreal injection of VEGF inhibitors and there is a theoretical risk that these may relate to VEGF inhibition'
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • Immediately after injection (§4.2): 'patients should be monitored for elevation in intraocular pressure. Appropriate monitoring may consist of a check for perfusion of the optic nerve head or tonometry. If required, sterile equipment for paracentesis should be available.'
  • Week after injection (§4.4): 'patients should be monitored during the week following the injection to permit early treatment if an infection occurs'
  • Patient-reported endophthalmitis symptoms (§4.2): 'patients should be instructed to report any symptoms suggestive of endophthalmitis (e.g. eye pain, redness of the eye, photophobia, blurring of vision) without delay'
  • Ongoing (§4.4): 'In all cases, both the intraocular pressure and the perfusion of the optic nerve head must therefore be monitored and managed appropriately.'
  • Disease activity (§4.2): 'Monitoring for disease activity may include clinical examination, functional testing or imaging techniques (e.g. optical coherence tomography or fluorescein angiography).' The schedule 'should be determined by the treating physician'
  • Immunogenicity (§4.4): 'Patients should be instructed to report any signs or symptoms of intraocular inflammation, e.g. pain, photophobia, or redness, which may be a clinical sign attributable to hypersensitivity.'
  • Traceability (§4.4): 'the name and the batch number of the administered product should be clearly recorded'

Clinical monograph

How it works

It acts as a soluble decoy receptor that binds VEGF-A, VEGF-B and placental growth factor, preventing their interaction with native receptors and thereby reducing pathological retinal vascular leakage and neovascularisation.

Prescribing in practice

  • Endophthalmitis is the most serious risk of intravitreal injection, so administer under strict aseptic technique and warn patients to report eye pain, increasing redness or vision loss urgently.
  • Measure and manage intraocular pressure, as transient rises can occur after injection.
  • Avoid in patients with active ocular or periocular infection or active intraocular inflammation.

Monitoring

Monitor visual acuity, intraocular pressure and the retina (including optical coherence tomography) before and after injections to guide ongoing treatment.

Counselling the patient

  • Seek urgent ophthalmic review for new eye pain, marked redness, increased floaters or sudden reduced vision after an injection.
  • Do not drive until vision has recovered after the procedure.
  • Attend all scheduled injection and review appointments, as treatment is given on an ongoing basis.

Evidence & guidelines

NICE recommends aflibercept across several retinal vascular indications, supported by the VIEW trials in neovascular AMD.

Reference: NICE TA294 (wet AMD); NICE TA509 (DMO); Eylea SPC; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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