Outcomes of and Surgical Technique for Treatment With High-Dose Aflibercept.

Purpose: To describe an alternate delivery of high-dose aflibercept using previous formulations (ie, prefilled syringe, vial, or compounded). Methods: A prospective pilot study was performed to analyze the short-term safety and visual gain (expressed in logMAR), including increase in intraocular pressure (IOP), resulting from a modified regimen consisting of 0.18 mL paracentesis followed by an intravitreal injection of 0.18 mL aflibercept (prefilled syringe), 0.20 mL aflibercept (vial), or 0.22 mL ziv-aflibercept (compounded). Results: The study comprised 32 eyes (16 naïve; 18 neovascular age-related macular degeneration; 8 retinal vein occlusion). Over a follow-up of 4.1 (± 3.2) months, a mean (± SD) of 1.7 (± 0.9) high-dose injections were administered. The baseline best spectacle-corrected vision was 1.35 ± 0.71 (Snellen VA) and improved to 0.68 ± 0.46 at 1 month (P < .001) and 0.57 ± 0.43 at the final follow-up (P < .001). An increase in IOP of 0.43 ± 4.26 mm Hg was seen 1 minute after injection (P = .58). In 2 eyes (6.3%), reflux as a tiny bleb was noted. Conclusions: When high-dose aflibercept is neither available nor affordable, a patient's readily accessible and cost-effective regimen of aflibercept will allow an exact delivery of high-dose aflibercept, combining minimal drug reflux, minimal immediate increase in IOP, and potential clinical efficacy in the short term.