Use of anti-VEGF drugs at the Instituto de la Visión de Montemorelos
1 Which anti-VEGF agents do we use?
We use bevazucimab (Avastin) – the dose used is 2.5 mg (0.1 ml). This anti-VEGF agent is used because of its:
- proven efficacy and effectiveness (CATT & IVAN studies)
- low cost, making it affordable for our patients.
2 What are the indications?
- Vitreous haemorrhage secondary to proliferative diabetic retinopathy – particularly when there has been no previous laser.
- Prior to vitrectomy for proliferative diabetic retinopathy.
- Clinically significant macular oedema due to diabetic retinopathy.
- Macular oedema secondary to branch or central retinal vein occlusion.
- Exudative age-related macular degeneration.
- Neovascular glaucoma.
3 Who gives the injections?
Intra-vitreal injections are always given by an ophthalmologist, for example:
- retina specialists
- retina subspecialty trainees
- ophthalmology residents in the retinal service.
4 Are anti-VEGF agents used without OCT?
Anti VEGF agents are used without OCT in selected cases:
- vitreous haemorrhage secondary to proliferative diabetic retinopathy – particularly when there has been no previous laser
- prior to vitrectomy for proliferative diabetic retinopathy
- clinically significant macular oedema due to diabetic retinopathy
- neovascular glaucoma.
5 What are the outcomes?
Clinical experience has been very positive and we believe this is a cost-effective treatment for our patients.
Vitreous haemorrhage secondary to proliferative diabetic retinopathy: We have been pleased with our results. Anti-angiogenic therapy reduces the vitreous haemorrhage in many patients with diabetic retinopathy, allowing us to apply laser and avoid vitrectomy surgery.
Prior to vitrectomy for proliferative diabetic retinopathy: Application 3–5 days before surgery reduces the risk of intra-operative and post-operative bleeding.
Neovascular glaucoma: In these patients, we are careful to avoid further increases in the IOP. When the rubeosis regresses we apply pan-retinal laser, giving us more control of the iris neovascularisation.Clinically significant macular oedema: In clinically significant macular oedema due to diabetic retinopathy, we normally apply three doses of Avastin with 1-month intervals between injections. After the last injection, a macular OCT is requested and, if the oedema has decreased, we apply focal laser.
Age-related macular degeneration (AMD): In patients with exudative AMD, an injection is given every month for several months to improve visual acuity and to control the disease, following the ‘treat and extend’ protocol.