Anti-VEGF injections

02 May Anti-VEGF injections

In certain diseases of the eye, a body chemical called VEGF (Vascular Endothelial Growth Factor) is released. This VEGF causes abnormal blood vessels to grow in the retina which tend to leak and affect the vision. Drugs that block the trouble-causing VEGF are called anti-VEGF drugs. These drugs slow down the growth of abnormal blood vessels in the eye.

They are used to treat wet age-related macular degeneration (AMD), diabetic eye disease and other problems of the retina like a retinal vein occlusion.

They are directly injected into the eye. Although it may be performed as an outpatient procedure, we prefer to inject it in the Operation Theatre to minimise the risk of infection.

Before the procedure, the eye is thoroughly cleaned and made numb with eye drops. A very thin needle (0.25mm) is passed through the white part of the eye and the drug is injected. Usually one does not see the needle itself. One may need to continue having these injections over many months.

Some of the possible risks with these injections include eye infection (risk less than 1 in 1000 injections) and even lesser risk of detached retina and cataract formation.

For about 24 hours after injection, it is normal to feel like there is something in the eye, and to have mild eye pain with extra sensitivity to light. If these or any other side effects last longer, please contact your doctor right away. Eye redness or a bloody eye can last for a few days.

The commonly used anti-VEGF injections include Ranibizumab (Lucentis, Razumab), Bevacizumab (Avastin) and Aflibercept (Eylea).

Lucentis and Eylea are US FDA approved for intra-vitreal use and are on the more expensive side. Avastin, although not FDA approved for use in the eye, is used “off-label” for these conditions. This is primarily done to reduce the costs of multiple injections. Avastin is available in a larger vial meant for injecting into the blood vessels of the hand (intravenous use) for a completely different disease (colorectal cancer). But since the quantity needed for injecting in the eye is very less, the vial is shared amongst patients thus reducing the load of the costs for everyone. While the effectiveness of Avastin has been well proven, there have been slightly higher reports of eye infection or reactions noted with Avastin.