EYLEA 40 mg/mL (aflibercept solution for intravitreal injection): Higher risk of intraocular pressure increase with the pre-filled syringe.

Summary

• Cases of increased intraocular pressure have been reported more frequently (estimated up approximately seven-fold) when using the Eylea pre-filled syringe, compared with administration with Luer-lock syringe of Eylea solution for injection in a vial.
• Incorrect handling in the preparation and injection is suspected as the most probable root cause of the observed cases of increased intraocular pressure with the Eylea pre-filled syringe. Injections should be performed by health care professionals familiar with the handling of this presentation.
• Correct handling of the pre-filled syringe and training are key to mitigate this risk: 
  • use a 30G x 13mm injection needle; 
  • always check that the excess volume/air bubbles in the pre-filled syringe is eliminated before use: the base of the plunger dome (not the tip of the dome) must be aligned with the black dosing line on the syringe (see below);
  • carefully depress the plunger rod;
  • administer the exact recommended dose and do not inject any residual volume, as increased injection volume can lead to clinically relevant intraocular pressure elevation.
• Evaluate the patient’s vision and monitor intraocular pressure immediately after the intravitreal injection.