Ziv-Aflibercept (Zaltrap; Sanofi-Aventis U.S LLS, Bridgewater, NJ) was originally introduced as an intravenous formulation for metastatic colorectal cancer. The adoption of Ziv-Aflibercept in ophthalmic practice was similar to bevacizumab, and reports have previously examined one to two year visual outcomes of Intravitreal Ziv-Aflibercept (IVZ) in age-related macular degeneration (AMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO). In this study the authors examined the prevalence of ocular adverse effects in eyes of patients who have received 10 or more IVZ injections (1.25 mg/0.05 ml) on pro-re-nata (PRN) or treat and extend (T&E) protocol. The primary study outcome was ocular and systemic adverse events related to IVZ injections whereas secondary outcomes were change in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT) at last visit compared to baseline. A total of 94 eyes which received a mean ± standard deviation (mean±SD = 14.4 ±4.6) IVZ injections were included. Forty-one eyes were treatment naïve, whereas 53 eyes received intravitreal injections in the past with last injection at least three months prior. Mean (±SD) follow-up period was 26.7 ±8.7 months. Ocular adverse events were limited with a case each of acute iridocyclitis, endophthalmitis, cataract progression and early epiretinal membrane formation. No systemic events were recorded within a month of IVZ injection. There was a significant improvement in BCVA (p=0.001) and change in CMT (p=0.001) at last follow-up. The authors conclude that ocular use of Ziv-Aflibercept is safe with limited ocular and systemic side-effects and multiple IVZ injections can be used for various chorioretinal diseases long-term.