Ophthalmology/Intravitreal anti-VEGFlow yield

Anti-VEGF (intravitreal)

also: ranibizumab · aflibercept · bevacizumab · wet AMD · VEGF

Overview

Intravitreal injections that halt neovascularisation — wet (neovascular) age-related macular degeneration and diabetic macular oedema.

Mechanism

Monoclonal antibody / fusion protein that binds vascular endothelial growth factor (VEGF) → inhibits abnormal choroidal/retinal neovascularisation and vascular leak → preserves/improves vision.

Indications

Wet (neovascular) AMD
Diabetic macular oedema / proliferative diabetic retinopathy
Retinal vein occlusion with macular oedema

The agents

Ranibizumab / afliberceptanti-VEGF

intravitreal, monthly→extended

Licensed for wet AMD/DMO.

Bevacizumabanti-VEGF

Off-label (cheaper) — used in some services.

Adverse effects

Endophthalmitis (injection-related)serious

Rare but sight-threatening — sterile technique; red painful eye after injection = urgent.

Raised IOP, retinal detachment, vitreous haemorrhagecommon

Small systemic arterial thromboembolic riskcommon

Cautions & contraindications

Active ocular/periocular infectionall

Interactions

Monitoring & kinetics

Visual acuity, OCT; watch for post-injection endophthalmitis

Intravitreal injection (specialist). Repeated, with monitoring.

Choosing it

true

Source: NICE — AMD / DMO · BNF — Anti-VEGF