Intravitreal anti-VEGF injections
- Drugs and toxicity
Injections into the eye that block VEGF have changed the outlook of wet macular degeneration and diabetic macular oedema. Pain and redness after one is urgent.
What it is
Vascular endothelial growth factor (VEGF) drives the leaky and abnormal new vessels of neovascular macular degeneration, diabetic macular oedema, retinal vein occlusion and proliferative retinopathy. Drugs that block it (bevacizumab, ranibizumab, aflibercept and newer agents) are injected into the vitreous in the clinic under local anaesthesia, usually monthly at first and then at intervals adjusted to the response.
What to know
- Indications: neovascular macular degeneration, diabetic macular oedema, macular oedema after vein occlusion, proliferative diabetic retinopathy, some retinopathy of prematurity.
- Procedure: topical anaesthesia, povidone-iodine antisepsis, lid speculum, injection through the pars plana.
- Most serious complication: endophthalmitis, rare.
- Others: raised eye pressure, retinal detachment, cataract from the needle, small subconjunctival bleeds (harmless).
Toxicity and risks
- Missing injections is the main cause of loss of the visual gain; treatment is usually long-term.
- Bevacizumab, the lowest-cost option, is widely used for the eye; other agents may need fewer injections.
- A theoretical risk of arterial thrombotic events is weighed in patients with recent stroke or heart attack.
Next step / Initial management
- New distortion or central blur in a known or suspected macular disease: ophthalmology within days.
- Pain, worsening redness or falling vision in the days after an injection: emergency for endophthalmitis.
- Help patients keep the injection schedule (transport, authorisations).
- Diabetes: control glucose, blood pressure and lipids alongside injections.
Test yourself
Think of the answer, then tap the question to see it.
Which diseases are treated with intravitreal anti-VEGF?
Neovascular macular degeneration, diabetic macular oedema, macular oedema from vein occlusion, proliferative diabetic retinopathy and some retinopathy of prematurity.
What must be suspected with pain and falling vision after an injection?
Endophthalmitis, an emergency.
What is the main cause of losing the visual gain from treatment?
Missing injections and losing follow-up.
Connections
In Pharmacology3
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Bevacizumab (StatPearls Publishing (NCBI Bookshelf), 2023); Ranibizumab (StatPearls Publishing (NCBI Bookshelf), 2023); Wet Age-Related Macular Degeneration (AMD) (StatPearls Publishing (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.