Synopsis
Explain how intravitreal anti-VEGF treatment is selected, delivered and monitored, including medicine-specific dosing, informed consent and the distinction between expected irritation and sight-threatening complications.
- Anti-VEGF medicines suppress pathological vascular leakage and neovascular activity; they do not restore every previously damaged retinal cell.
- The diagnosis, the licensed product and current disease activity determine the injection schedule.
- A dry optical coherence tomography scan may show treatment success rather than permanent elimination of the underlying disease.
Key red flags
A painful red eye with reduced sight after an injection is an emergency even when the patient initially felt well after the procedure.
Investigation priorities
Establish benefit, deterioration and the patient's treatment priorities.
Management branches
Retinal assessment identifies active disease for which an anti-VEGF treatment is appropriate.
- Confirm diagnosis, laterality, visual potential and the reason for preferring the proposed medicine over other appropriate options.
- Discuss realistic benefit, repeated attendance, procedure risks and an individual plan for monitoring and urgent advice.
Key medicines
Ranibizumab, Lucentis 10 mg/mL, adult intravitreal regimenGive 0.5 mg in 0.05 mL into the vitreous of the affected eye; allow at least four weeks between doses in that eye. Begin monthly until maximal acuity and/or absence of disease activity, then individualise according to the indication and response.
Bevacizumab gamma, Lytenava 25 mg/mL, wet AMDGive 1.25 mg in 0.05 mL intravitreally into the affected eye every four weeks initially until maximal visual acuity and/or inactivity; three or more consecutive monthly injections may be required, followed by an individualised schedule.