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Purpose: To report 1.5-year real-world outcomes on the incidence of sterile intraocular inflammation (IOI) following intravitreal aflibercept 8 mg injections, with emphasis on differences between vial and pre-filled syringe (PFS) use.

Methods: This retrospective multicenter study reviewed electronic medical records of all patients who received aflibercept 8 mg injections at Vista Augenklinik sites between March 1, 2024, and November 30, 2025. The primary outcome was the incidence of IOI per injection. Secondary analyses included stratification by treatment indication and by vial versus PFS administration.

Results: A total of 2,631 injections were administered to 453 eyes of 398 patients. IOI was documented in 41 eyes (37 patients), corresponding to an incidence of 1.56% per injection (95% confidence interval [CI], 1.21–2.41), 9.05% per eye (95% CI, 7.13–13.0), and 9.30% per patient (95% CI, 7.0–13.32). Mean time to presentation was 7.3 days (range 2–31) after a mean of 4.7 injections. All cases presented with anterior chamber and/or vitreous inflammation without posterior involvement. No retinal vasculitis or infiltrates were observed. Inflammation resolved with topical corticosteroids and/or NSAIDs, with no significant change in best-corrected visual acuity (VA) compared to pre-event VA (20/32 versus 20/35 Snellen equivalent, p=0.62). The incidence differed significantly between formulations: 2.26% per injection with the vial versus 0.21% per injection with the PFS (p=0.010).

Conclusion: In a real-world setting, aflibercept 8 mg was associated with a higher incidence of IOI than reported in pivotal trials, particularly when administered from vials. Conversion to the PFS markedly reduced the incidence, suggesting a formulation- or preparation-related effect. All cases were mild, anterior, and reversible under topical therapy without long-term visual impact.