# Switching From Aflibercept 2 mg to 8 mg in Vitrectomized Eyes With Neovascular Age-Related Macular Degeneration

## TL;DR

A higher dose of aflibercept (8 mg) may improve treatment outcomes in vitrectomized eyes with neovascular age-related macular degeneration.

## Contribution

The study introduces aflibercept 8 mg as a potential treatment for vitrectomized eyes with nAMD, where conventional doses are less effective.

## Key findings

- Switching to aflibercept 8 mg resolved fluid in all three vitrectomized nAMD eyes.
- Treatment intervals could be extended without adverse events in these cases.
- The 8 mg dose may offer better durability and reduce treatment burden in vitrectomized patients.

## Abstract

Vitrectomy may alter intravitreal pharmacokinetics through the removal of the vitreous gel, potentially accelerating the clearance of anti-vascular endothelial growth factor (VEGF) agents. Clinical trials and most real-world studies on neovascular age-related macular degeneration (nAMD) generally exclude vitrectomized eyes, and the efficacy of anti-VEGF therapy in this subgroup remains unclear. Aflibercept 8 mg, approved in Japan in 2024, delivers four times the dose of the conventional 2 mg formulation and is designed to improve durability and extend treatment intervals. We report three vitrectomized eyes from three patients with nAMD who exhibited persistent or recurrent exudation despite short-interval (≤8 weeks) aflibercept 2 mg therapy under a treat-and-extend regimen. Switching to aflibercept 8 mg led to the resolution of fluid in all cases and enabled interval extension. No ocular or systemic adverse events were observed. These findings suggest that aflibercept 8 mg can achieve improved anatomical outcomes and greater treatment durability in vitrectomized eyes with nAMD, thereby potentially reducing the treatment burden in this challenging subgroup. Larger prospective studies are required to validate these findings.