Intravitreal Injections are increasingly important for patients with retinal diseases. Many of these treatments are directed at inhibiting Vascular Endothelial Growth Factor (VEGF). Vascular Endothelial Growth Factor (VEGF) is a substance made by cells that stimulates the growth and leakage of abnormal new blood vessels. VEGF plays a large role in the development of wet age-related macular degeneration (AMD) and other retinal vascular diseases. Multiple new treatments for wet age related macular degeneration that block VEGF are now clinically available. These treatments are given as a series of injections into the eye (intravitreal injection). Intravitreal injections are performed in the office, using an anesthetic to minimize patient discomfort and antiseptic to minimize the risk of infection. Patients are able to continue with all normal activities after an injection. In many cases, repeated injections are necessary to achieve the desired effect.
Pegaptanib (Macugen): was the first of these agents to become available, gaining FDA approval in December of 2004. Macugen binds and inactivates a VEGF subtype (VEGF-165) thought to be most important in disease progression.
Bevacizumab (Avastin): is an anti-VEGF treatment that is FDA approved for intravenous use in metastatic colon cancer. Due to its similarity to other anti-VEGF agents used in macular degeneration and its widespread availability, Avastin has become commonly used by retina specialists in small doses as an intravitreal injection. Avastin is used in an off-label (non-FDA approved) fashion for treating wet age related macular degeneration, diabetic retinopathy, and retinal vein occlusions. Although mounting evidence has demonstrated the effectiveness and safety of Avastin, further trials are underway to investigate the use of Avastin inside the eye.
Ranibizumab (Lucentis): is the newest and most effective anti-VEGF agent approved by the FDA for the treatment of wet age-related macular degeneration (AMD). In 2 clinical trials, a majority of patients receiving monthly injections of ranibizumab maintained their vision. Moreover, approximately one-third of ranibizumab patients had improvements in vision at 12 months. Lucentis is the first treatment for wet macular degeneration to show an average improvement in visual acuity after one year of treatment in clinical studies.
Triamcinolone acetonide and other corticosteroids: corticosteroids are used throughout medicine, and extensively in ophthalmology. Off-label use of triamcinolone acetonide (Kenalog ™) or dexamethasone as an intravitreal injection is sometimes used to help in the treatment of wet age-related macular degeneration; to decrease inflammation; and to decrease swelling of the retina (macular edema) associated with diabetic retinopathy or retinal vascular occlusions.
The physicians at Vitreoretinal Consultants have extensive experience with the use of all of the anti-VEGF agents. Clinical trials with anti-VEGF agents are continuing to find new ways to treat devastating retinal diseases.
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