Eylea (Aflibercept)
Anti-VEGF intravitreal injection for retinal eye diseases
Quick Facts About Eylea
Key Takeaways About Eylea
- Anti-VEGF eye injection: Eylea blocks abnormal blood vessel growth and fluid leakage in the retina, treating conditions that cause vision loss
- Treats multiple eye conditions: Approved for wet AMD, diabetic macular edema, retinal vein occlusion, and myopic CNV
- Administered by a specialist: Eylea must be injected into the eye by a qualified ophthalmologist under sterile conditions with local anesthesia
- Regular treatment schedule: Most conditions require monthly injections initially, with intervals extended based on individual response
- Can stabilize and improve vision: Clinical trials show Eylea stops further vision loss in most patients and improves visual acuity in many
What Is Eylea and What Is It Used For?
Eylea (aflibercept) is a prescription medication injected directly into the eye (intravitreal injection) to treat retinal diseases caused by abnormal blood vessel growth and fluid leakage. It works by blocking vascular endothelial growth factor A (VEGF-A) and placental growth factor (PlGF), preventing the formation of new leaky blood vessels in the eye.
Eylea belongs to a class of medications known as anti-VEGF (vascular endothelial growth factor) inhibitors. The active substance, aflibercept, is a recombinant fusion protein that acts as a soluble decoy receptor. It binds to VEGF-A, VEGF-B, and PlGF with higher affinity than their natural receptors, effectively neutralizing these growth factors and preventing them from triggering the formation of abnormal blood vessels in the eye.
Eylea is approved for the treatment of several serious eye conditions in adults. In wet age-related macular degeneration (wet AMD), an excess of VEGF contributes to the abnormal formation of new blood vessels in the eye. These fragile new vessels can leak blood and fluid into the retina, damaging the light-sensitive tissue responsible for central vision. Left untreated, wet AMD can lead to rapid and severe vision loss. Eylea helps stop this process by blocking the growth factors that drive new vessel formation.
In retinal vein occlusion (RVO), a blockage occurs in the blood vessels that carry blood away from the retina. This blockage can affect either the central retinal vein (CRVO) or one of its branches (BRVO). When the vein is blocked, blood and fluid back up into the retina, causing the macula (the central part of the retina responsible for sharp, detailed vision) to swell. This swelling, called macular edema, results in blurred central vision. Eylea reduces this swelling by blocking the excess VEGF that causes fluid leakage.
Diabetic macular edema (DME) is a complication of diabetes in which high blood sugar levels damage the small blood vessels in the retina. These damaged vessels leak fluid into the macula, causing it to swell and resulting in blurred or distorted vision. DME is one of the leading causes of vision loss in people with diabetes. Eylea has demonstrated effectiveness in reducing macular swelling and improving visual acuity in patients with DME.
In myopic choroidal neovascularization (myopic CNV), patients with severe nearsightedness (high myopia) develop abnormal new blood vessels beneath the retina. These vessels can leak and bleed, causing damage to the macula and resulting in vision loss. Eylea is effective in treating this condition, often requiring fewer injections than other indications.
Clinical trials have consistently shown that Eylea can stop the growth of new abnormal blood vessels in the eye, reduce fluid leakage, and stabilize or improve vision in the majority of patients across all approved indications. Many patients experience measurable improvements in visual acuity, particularly when treatment is initiated early in the disease course.
Aflibercept works like a molecular sponge. It binds to VEGF-A and PlGF in the eye before these growth factors can attach to their receptors on blood vessel cells. By intercepting these signals, Eylea prevents the cascade of events that leads to abnormal blood vessel growth, reduces existing vessel leakiness, and helps restore the normal fluid balance in the retina. This mechanism of action is what allows Eylea to effectively treat conditions driven by excess VEGF activity.
What Should You Know Before Receiving Eylea?
Eylea must not be used if you have a known allergy to aflibercept, an active or suspected eye infection, or severe eye inflammation. Before treatment, inform your ophthalmologist about any history of glaucoma, recent eye surgery, or cardiovascular conditions such as stroke or heart attack.
Before receiving Eylea, it is essential that your treating ophthalmologist has a complete picture of your medical history and current health status. Anti-VEGF therapies are powerful medications, and while they are generally well tolerated when administered correctly, there are important contraindications, warnings, and precautions that must be considered to ensure your safety.
Contraindications
You must not be treated with Eylea if any of the following apply:
- Allergy to aflibercept: If you are allergic to aflibercept or any of the other ingredients in Eylea (including polysorbat 20, sodium chloride, sucrose, sodium dihydrogen phosphate, or disodium hydrogen phosphate)
- Active or suspected eye infection: If you have an active or suspected infection in or around the eye (ocular or periocular infection), treatment must be postponed until the infection is fully resolved
- Severe eye inflammation: If you have severe intraocular inflammation (characterized by eye pain and redness), Eylea should not be administered until the inflammation subsides
Warnings and Precautions
Talk to your ophthalmologist before receiving Eylea if any of the following apply to you:
- Glaucoma: If you have glaucoma (elevated intraocular pressure), as Eylea injections may cause temporary increases in eye pressure
- Visual disturbances: If you have experienced flashes of light or floaters in your vision, or if you notice a sudden increase in their number or size
- Recent or planned eye surgery: If you have had eye surgery within the past four weeks or are planning surgery within the next four weeks
- Ischemic RVO: If you have a severe form of CRVO or BRVO (ischemic), Eylea treatment is not recommended
It is also important to be aware of the following:
- The safety and efficacy of Eylea administered in both eyes simultaneously has not been studied and may increase the risk of side effects
- Intravitreal injections can cause a temporary increase in intraocular pressure (IOP) within 60 minutes of injection. Your ophthalmologist will monitor your IOP after each injection
- Signs of serious complications include eye pain, worsening redness, blurred or decreased vision, and increased light sensitivity. Report these symptoms immediately to your ophthalmologist
- Your doctor will assess risk factors for retinal detachment or tears, and for tears in the retinal pigment epithelium, before administering Eylea
Systemic use of VEGF inhibitors (substances similar to those in Eylea) has been associated with an increased risk of arterial thromboembolic events, potentially leading to heart attack or stroke. While the systemic exposure from intravitreal injection is much lower, a theoretical risk exists. Patients who have had a stroke, transient ischemic attack (mini-stroke), or heart attack within the past 6 months should discuss this risk carefully with their doctor before starting Eylea treatment.
Pregnancy and Breastfeeding
Eylea should not be used during pregnancy unless the potential benefits clearly outweigh the potential risks to the unborn child. There is no clinical experience with Eylea use in pregnant women. Women of childbearing potential must use effective contraception during treatment and for at least 3 months after the last injection of Eylea.
Small amounts of aflibercept may pass into breast milk. The effects on breastfed infants are unknown. Eylea is not recommended during breastfeeding. If you are breastfeeding, discuss with your doctor whether the benefits of treatment outweigh the potential risks to your infant.
Children and Adolescents
Eylea has not been studied in children and adolescents under 18 years of age. The conditions Eylea treats (wet AMD, CRVO, BRVO, DME, and myopic CNV) primarily affect adults, making pediatric use not relevant for these indications.
Driving and Operating Machinery
After receiving an Eylea injection, you may experience temporary visual disturbances such as blurred vision. Do not drive or operate machinery until these symptoms have resolved. Most patients find that vision returns to normal within a few hours of the injection, but individual recovery times may vary.
How Does Eylea Interact with Other Drugs?
Eylea has minimal known drug interactions because it is administered locally into the eye rather than taken systemically. However, patients using blood-thinning medications (anticoagulants) may have an increased risk of eye bleeding after injection. Always inform your ophthalmologist about all medications you are currently taking.
Because Eylea is injected directly into the vitreous humor of the eye, its systemic absorption is very low compared to oral or intravenous medications. This means that significant drug-drug interactions are uncommon. However, there are some important considerations regarding concurrent medications that patients and healthcare providers should be aware of.
No formal drug interaction studies have been conducted with Eylea. The information below is based on pharmacological properties, clinical experience, and known effects of anti-VEGF agents as a class.
| Medication | Interaction Type | Clinical Significance | Recommendation |
|---|---|---|---|
| Anticoagulants (warfarin, heparin) | Increased bleeding risk | Moderate | Increased risk of conjunctival hemorrhage; continue medication but inform ophthalmologist |
| Antiplatelet agents (aspirin, clopidogrel) | Increased bleeding risk | Low to moderate | Continue medication; slightly higher incidence of subconjunctival hemorrhage noted in clinical trials |
| Other anti-VEGF agents (ranibizumab, bevacizumab) | Additive VEGF suppression | High | Do not use simultaneously; allow adequate washout period between switching agents |
| Topical eye drops (antibiotics, steroids) | Minimal interaction | Low | Pre- and post-injection topical antibiotics are standard protocol and do not interact with Eylea |
| Systemic corticosteroids | Potential additive IOP effects | Low | Monitor intraocular pressure; systemic steroids may independently raise IOP in susceptible individuals |
In clinical trials for wet AMD, an increased incidence of conjunctival hemorrhage (bleeding from the small blood vessels in the outer tissue layers of the eye) was observed in patients taking blood-thinning medications. This increased incidence was similar between patients treated with Eylea and those treated with ranibizumab (Lucentis), suggesting it is related to the injection procedure rather than a specific interaction with aflibercept.
Always inform your ophthalmologist about all medicines you are taking, have recently taken, or might take, including over-the-counter medications and supplements. While most medications do not significantly interact with Eylea, your doctor needs a complete medication list to provide the safest possible care.
What Is the Correct Dosage of Eylea?
The standard dose of Eylea is 2 mg aflibercept (0.05 ml) given as an intravitreal injection. Treatment schedules vary by condition: wet AMD starts with monthly injections for 3 months then every 2 months; DME starts monthly for 5 doses then every 2 months; RVO is given monthly until stable; myopic CNV may require only a single injection.
Eylea must be administered exclusively by a qualified ophthalmologist experienced in performing intravitreal injections. The procedure is performed under aseptic (clean and sterile) conditions. Before the injection, your doctor will thoroughly cleanse your eye with an antiseptic wash and administer local anesthesia (numbing drops) to minimize or eliminate pain during the procedure.
The recommended dose for all approved indications is 2 mg aflibercept, corresponding to 0.05 ml of solution. The injection is delivered directly into the vitreous body of the eye using a very fine 30-gauge needle.
| Condition | Loading Phase | Maintenance Phase | Notes |
|---|---|---|---|
| Wet AMD | 1 injection monthly for 3 months | 1 injection every 2 months; interval may be extended by 2-4 weeks if stable | Interval can be shortened if condition worsens |
| DME | 1 injection monthly for 5 months | 1 injection every 2 months; adjusted based on response | Doctor may discontinue if no benefit from continued treatment |
| CRVO | 1 injection monthly until stable | Gradual interval extension based on response | Minimum interval: 1 month; typically 3+ injections needed |
| BRVO | 1 injection monthly until stable | Gradual interval extension based on response | Minimum interval: 1 month; doctor may stop if no benefit |
| Myopic CNV | Single injection | Additional injections only if condition recurs or does not improve | Minimum interval: 1 month between injections |
Adults
All adult dosing follows the schedules outlined in the table above. The treating ophthalmologist will determine the most appropriate treatment regimen based on your specific condition, disease severity, and individual response to therapy. Treatment intervals may be gradually extended if your condition remains stable, or shortened if your condition worsens. Regular monitoring visits are essential to assess treatment response and adjust the schedule accordingly.
For wet AMD patients, after the initial three monthly loading doses and one injection two months later, the doctor will decide whether to continue with bimonthly injections or gradually extend the interval. This individualized approach, known as "treat and extend," allows for fewer injections while maintaining optimal visual outcomes.
Elderly Patients
No dose adjustment is necessary for elderly patients. The majority of patients receiving Eylea for wet AMD are over 65 years of age, and clinical trials have included patients up to their 90s. The standard 2 mg dose is appropriate regardless of age. However, elderly patients may have additional comorbidities that require careful consideration before and during treatment.
Missed Dose
If you miss a scheduled Eylea injection, contact your ophthalmologist as soon as possible to arrange a new appointment for examination and injection. Missing doses can allow your eye condition to progress, potentially resulting in vision loss. It is important to maintain your treatment schedule as closely as possible to achieve the best visual outcomes.
Overdose
Since Eylea is administered by a healthcare professional in a controlled clinical setting, the risk of overdose is extremely low. The vial contains more than the required dose to allow for proper preparation, and excess solution is discarded before injection. If an overdose were to occur, the primary concern would be elevated intraocular pressure, which would be monitored and managed by your ophthalmologist.
What Are the Side Effects of Eylea?
The most common side effects of Eylea include decreased visual acuity, retinal hemorrhage, conjunctival hemorrhage (red eye), and eye pain, occurring in more than 1 in 10 patients. Serious but rare side effects include endophthalmitis (severe eye infection), retinal detachment, and cataracts. Seek immediate medical attention if you experience sudden vision loss, increasing eye pain, or worsening redness after injection.
Like all medicines, Eylea can cause side effects, although not everybody experiences them. Many side effects are related to the injection procedure itself rather than the medication. In clinical studies, serious eye-related side effects (including blindness, endophthalmitis, retinal detachment, and vitreous hemorrhage) occurred in fewer than 1 in 1,900 injections.
Allergic reactions (hypersensitivity) may occur. These can be serious and may require immediate medical attention. If you experience symptoms of a severe allergic reaction such as rash, itching, hives, or difficulty breathing after an Eylea injection, seek medical help immediately.
Sudden decrease in vision, increasing pain and redness in the eye, or any other new visual symptoms after your Eylea injection. These may be signs of serious complications such as endophthalmitis (eye infection) or retinal detachment that require urgent treatment.
Very Common
- Decreased visual acuity (worsening of vision)
- Retinal hemorrhage (bleeding in the back of the eye)
- Conjunctival hemorrhage (red eye from broken small blood vessels)
- Eye pain
Common
- Retinal pigment epithelial detachment or tear
- Retinal degeneration (causing visual disturbance)
- Vitreous hemorrhage (bleeding inside the eye)
- Cataract (certain types of lens clouding)
- Corneal damage (front layer of the eye)
- Increased intraocular pressure
- Floaters (moving spots in visual field)
- Vitreous detachment (flashes and floaters)
- Foreign body sensation in the eye
- Increased tearing
- Eyelid swelling
- Bleeding at injection site
- Eye redness
Uncommon
- Allergic reactions (hypersensitivity) including rash, itching, hives
- Endophthalmitis (serious infection inside the eye)
- Iritis, uveitis, iridocyclitis (inflammation of parts of the eye)
- Abnormal sensation in the eye
- Eyelid irritation
- Corneal edema (swelling of the front layer of the eye)
Rare
- Blindness
- Traumatic cataract (lens clouding due to injury)
- Vitritis (inflammation of the vitreous body)
- Hypopyon (pus in the eye)
Additional safety information: As with all therapeutic proteins, there is a potential for an immune response (antibody formation) with Eylea. Systemic use of VEGF inhibitors has been associated with a theoretical risk of arterial thromboembolic events (blood clots that can lead to heart attack or stroke) after intravitreal injection. Patients with a recent history of cardiovascular events should be monitored carefully.
Scleritis (inflammation of the white of the eye with redness and pain) has also been reported with unknown frequency. If you experience any side effects not listed here, or if any side effect becomes severe, contact your ophthalmologist or healthcare provider immediately.
How Should Eylea Be Stored?
Eylea must be stored in a refrigerator at 2-8°C (36-46°F) and must not be frozen. The unopened vial may be stored at room temperature (up to 25°C / 77°F) for up to 24 hours. Keep in the original packaging to protect from light. Store out of reach of children.
Proper storage of Eylea is critical to maintaining its effectiveness and safety. As a biological medicine (a recombinant fusion protein), aflibercept is sensitive to temperature extremes and light exposure. Improper storage can cause the protein to degrade, potentially reducing its efficacy or increasing the risk of adverse reactions.
- Refrigeration required: Store at 2°C to 8°C (36°F to 46°F). Do not freeze the medication
- Temporary room temperature storage: The unopened vial may be kept at room temperature (up to 25°C / 77°F) for a maximum of 24 hours prior to use
- Light protection: Keep the vial in its original packaging to protect from light
- Expiration date: Do not use after the expiry date printed on the carton and label (EXP). The expiry date refers to the last day of that month
- Single use only: Each vial is intended for the treatment of one eye only. Drawing multiple doses from a single-use vial increases the risk of contamination and subsequent infection
- Disposal: Unused medicine should not be disposed of via wastewater or household waste. Ask your pharmacist about proper disposal methods
In clinical practice, Eylea is stored and handled by the healthcare facility where you receive your injections. The ophthalmologist and pharmacy staff are responsible for ensuring proper storage conditions are maintained. The solution should be visually inspected before use for particles, discoloration, or any other abnormality. If any abnormalities are observed, the vial must be discarded.
What Does Eylea Contain?
Eylea contains aflibercept as its active ingredient, with each vial providing at least 4 mg of aflibercept (minimum 0.1 ml extractable volume) at a concentration of 40 mg/ml. The recommended dose of 2 mg is delivered in 0.05 ml. Inactive ingredients include polysorbat 20, sodium chloride, sucrose, and phosphate buffers.
Understanding the composition of Eylea can help patients and healthcare providers identify potential allergens and understand how the medication is formulated. Each component serves a specific purpose in maintaining the stability, pH, and osmolality of the solution.
Active Ingredient
The active substance is aflibercept. Each vial contains an extractable volume of at least 0.1 ml, corresponding to at least 4 mg of aflibercept. A single dose of 2 mg aflibercept is delivered in 0.05 ml of solution. Aflibercept is a recombinant fusion protein produced in Chinese Hamster Ovary (CHO) cells using recombinant DNA technology.
Inactive Ingredients (Excipients)
- Polysorbat 20 (E 432): A surfactant that helps stabilize the protein in solution. Each 0.05 ml dose contains 0.015 mg of polysorbat 20 (equivalent to 0.3 mg/ml). Polysorbates may cause allergic reactions in susceptible individuals
- Sodium dihydrogen phosphate monohydrate: A buffering agent used to maintain the correct pH
- Disodium hydrogen phosphate heptahydrate: A buffering agent that works in conjunction with sodium dihydrogen phosphate
- Sodium chloride: Used to adjust the osmolality (salt concentration) of the solution to be compatible with the eye
- Sucrose: A stabilizer that helps protect the aflibercept protein from degradation
- Water for injections: The solvent in which all ingredients are dissolved
The solution is colorless to pale yellow. Each package contains 1 vial plus 1 filter needle. The medication contains less than 1 mmol (23 mg) of sodium per dose unit, meaning it is essentially sodium-free.
If you have known allergies to polysorbates, inform your ophthalmologist before receiving Eylea. Polysorbat 20, contained in the formulation at a concentration of 0.3 mg/ml, may cause allergic reactions in some individuals.
Frequently Asked Questions About Eylea
Eylea (aflibercept) is used to treat several serious eye conditions caused by abnormal blood vessel growth and fluid leakage in the retina. These include wet age-related macular degeneration (wet AMD), diabetic macular edema (DME), macular edema secondary to retinal vein occlusion (both branch and central types), and myopic choroidal neovascularization (myopic CNV). By blocking VEGF, Eylea helps stop vision loss and can improve visual acuity in many patients.
The injection frequency depends on your specific condition. For wet AMD, treatment typically begins with monthly injections for 3 months, followed by injections every 2 months, with intervals potentially extended if your condition is stable. For DME, you receive monthly injections for the first 5 months, then every 2 months. For retinal vein occlusion, monthly injections continue until the condition stabilizes. Myopic CNV may require only a single injection. Your ophthalmologist will personalize your treatment schedule based on how you respond.
The most common side effects (affecting more than 1 in 10 patients) include decreased visual acuity, retinal hemorrhage, conjunctival hemorrhage (red eye from broken blood vessels on the eye surface), and eye pain. These are generally mild to moderate and often related to the injection procedure itself. Serious complications such as endophthalmitis (eye infection), retinal detachment, and significant vision loss are rare, occurring in fewer than 1 in 1,900 injections.
Before the Eylea injection, your ophthalmologist applies local anesthetic drops to numb your eye, which greatly reduces or eliminates pain. Most patients report feeling only mild pressure or a brief sensation during the injection, which takes just seconds to complete. Some patients experience a gritty or irritated feeling in the eye after the anesthetic wears off, but this typically resolves within hours. The very fine 30-gauge needle used for the injection minimizes discomfort.
Eylea (aflibercept) is one of several anti-VEGF treatments available, including ranibizumab (Lucentis) and bevacizumab (Avastin). Large-scale clinical trials (VIEW 1 and VIEW 2) demonstrated that Eylea given every 2 months after a loading phase was non-inferior to monthly ranibizumab for wet AMD. Eylea may offer the advantage of less frequent dosing for some conditions. The choice of anti-VEGF agent depends on the specific diagnosis, patient factors, treatment response, and clinical judgment of the ophthalmologist.
Eylea has been shown to stabilize vision in the majority of patients and can improve visual acuity in many cases. In landmark clinical trials for wet AMD, approximately 30-40% of patients gained 15 or more letters on a standard eye chart after one year of treatment. However, the degree of vision recovery depends on several factors, including the extent of existing retinal damage, how early treatment is started, and individual patient characteristics. Early detection and treatment generally lead to the best visual outcomes, which is why regular eye examinations are so important.
References
This article is based on the following peer-reviewed sources and international medical guidelines:
- European Medicines Agency (EMA). "Eylea (aflibercept) - Summary of Product Characteristics." EMA, last updated 2024. Available at: ema.europa.eu/en/medicines/human/EPAR/eylea
- Heier JS, Brown DM, Chong V, et al. "Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration." Ophthalmology. 2012;119(12):2537-2548. doi:10.1016/j.ophtha.2012.09.006
- Brown DM, Schmidt-Erfurth U, Do DV, et al. "Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID studies." Ophthalmology. 2015;122(10):2044-2052. doi:10.1016/j.ophtha.2015.06.017
- U.S. Food and Drug Administration (FDA). "EYLEA (aflibercept) Injection, for Intravitreal Use - Prescribing Information." FDA, 2024.
- Royal College of Ophthalmologists. "Age-Related Macular Degeneration: Guidelines for Management." RCOphth, 2023.
- World Health Organization (WHO). "WHO Model List of Essential Medicines - 23rd List." WHO, 2023.
- Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. "Five-Year Outcomes with Anti-VEGF Treatment of Neovascular AMD." Ophthalmology. 2016;123(8):1751-1761.
- Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. "Intravitreal aflibercept for diabetic macular edema." Ophthalmology. 2014;121(11):2247-2254.
About the Medical Editorial Team
This article has been written and medically reviewed by the iMedic Medical Editorial Team, which includes specialist physicians in ophthalmology, pharmacology, and internal medicine. Our editorial process follows the GRADE evidence framework, and all medical claims are supported by peer-reviewed research and international guidelines from the EMA, FDA, WHO, and Royal College of Ophthalmologists.
All information is based on Level 1A evidence from systematic reviews, meta-analyses, and randomized controlled trials. Treatment guidelines follow international standards.
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