Aflibercept

Mechanism of action

◆VEGF-A (and placental growth factor), bound as a soluble decoyAflibercept

ⓘ The figure shows human VEGF bound to domain 2 of VEGF receptor 1 (FLT-1), one of the receptor pieces built into aflibercept.

Aflibercept is a recombinant fusion protein made of parts of human VEGF receptors 1 and 2 joined to an antibody Fc segment. It works as a soluble decoy: it binds VEGF-A and placental growth factor so they cannot activate receptors on retinal endothelial cells. This reduces abnormal vessel growth and leakage, so macular oedema falls and vision can be kept or improved.

1. Aflibercept is injected into the vitreous
2. It traps VEGF-A and placental growth factor
3. Retinal endothelial receptors are not activated
4. Less new-vessel growth and leakage; oedema falls

Indications

• Wet (neovascular) age-related macular degeneration Age-related macular degeneration →
• Diabetic macular oedema and diabetic retinopathy Diabetic retinopathy →
• Macular oedema after retinal vein occlusion Central retinal vein occlusion →
• Retinopathy of prematurity Retinopathy of prematurity →

Adverse effects

Common

• Feeling of something in the eye
• Watery eyes
• Brief blurred vision after the injection

Contraindications

• Active infection in or around the eye
• Active intraocular inflammation
• Hypersensitivity to aflibercept or any component

Key interactions

Other anti-VEGF agents in the same eye

Same target and same injection risks; they are not combined

What is monitored

• Intraocular pressure and optic nerve perfusion after each injection
• Signs of endophthalmitis or a retinal problem in the days after
• Visual acuity and retinal imaging at follow-up

Administration and safety

• Intravitreal injection only, given by a qualified eye specialist under aseptic conditions.
• Several products contain aflibercept under different names and strengths; the exact product ordered is checked, since they are not interchangeable without a prescriber's decision.
• The patient should not drive until vision returns to normal after the injection.

Pregnancy and breastfeeding

Pregnancy should be avoided before and during treatment and for some months after the last injection, with effective contraception.

Nursing care

• Before the injection, ask about eye infection, redness, swelling or eye inflammation.
• After the injection, check the patient's vision and make sure eye pressure is checked.
• Teach the warning signs: increasing pain, redness, light sensitivity, new floaters or loss of vision, to be reported at once.
• Teach stroke and heart-attack warning signs.
• Remind about effective contraception during treatment and for some months after the last injection.

Pharmacokinetics

Absorption

Given into the vitreous; it acts locally in the eye and little reaches the blood

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Connections

← Back to the class: Intravitreal anti-VEGF agents

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Aflibercept Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); RCSB PDB - 1FLT: VEGF IN COMPLEX WITH DOMAIN 2 OF THE FLT-1 RECEPTOR (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.