Understanding Aflibercept’s Structural Design and Use of High-Dose in Retinal Vascular Diseases

The panel reviews why aflibercept has remained a mainstay since its 2-mg approval, emphasizing its VEGF “trap” design, high binding affinity, fully human fusion protein architecture, and low immunogenicity—features associated with reliable anatomic responses and minimal tachyphylaxis. Clinically, aflibercept’s predictability enables consistent treat-and-extend intervals easing clinic flow and patient counseling. Discussion then shifts to aflibercept 8 mg, now approved for AMD and DME (with RVO pending). The higher molar dose increases intravitreal VEGF-binding capacity, translating to faster drying in some patients and longer durability versus 2 mg, allowing extended dosing for appropriate candidates. Overall, the session highlights structure–function principles, practical interval setting, and how the 8-mg formulation may raise the ceiling on fluid control and convenience.