Subretinal fluid resolution in the fellow eye after unilateral aflibercept injection in bilateral neovascular age-related macular degeneration: Coincidence or systemic effect?

We report a case of bilateral neovascular age-related macular degeneration (nAMD) in which a unilateral aflibercept injection led to complete resolution of subretinal fluid (SRF) in the untreated fellow eye. A 63-year-old woman undergoing treat-and-extend therapy for the right eye developed new SRF in the left eye, which maintained good vision (best-corrected visual acuity, 0.8). To avoid injection-related risks in a high-vision eye, only the right eye was treated. Three weeks later, optical coherence tomography demonstrated complete SRF resolution in the left eye, which persisted for 8 weeks before recurrence. This case raises the possibility that systemic absorption of anti-vascular endothelial growth factor (anti-VEGF) may temporarily suppress choroidal neovascularisation activity in the fellow eye. However, this single observation cannot guide clinical practice and requires prospective validation.