Anti VEGF Agents

introduction

What is VEGF?

Vascular endothelial Growth factor (VEGF) is a protein produced in the human body which is responsible for production of new vessels and maintaining them. Under abnormal conditions like diabetic retinopathy, blood vessels obstruction and age related macular degeneration it causes formation of abnormal vessels which bleed, leak and ultimately lead to scar formation and vision loss

What are anti VEGF Agents

Anti Vascular endothelial Growth factor (anti VEGF) agents a group of medications which block the activity of VEGF and thus mitigate the abnormal effects of VEGF

 

What are the anti VEGF Agents available for treatment

  • Bevacizumab
  • Ranibizumab
  • Aflibercept
  • Brolucizumab


How are these anti VEGF agents different from one another

 

Bevacizumab

Ranibizumab

Aflibercept

Brolucizumab

Molecule

Monoclonal antibody

Antibody fragment

Fusion protein

Single chain antibody

Molecular weight

149 kDa

48kDa

97-115 kDa

26 kDa

Clinical dose

1.25 mg

0.5 mg

2 mg

6 mg

FDA approval

Not approved

Approved

Approved

Approved

Intravitreal anti VEGF activity

4 weeks

4 weeks

Upto 12 weeks

Upto 12 weeks

 

 

How have anti VEGF treatment influenced the management of various eye conditions

Anti VEGF agents when administered under appropriate conditions act at molecular level countering the action of VEGF and thereby reducing the morbidity.

Many diseases which were considered untreatable earlier like age related macular degeneration are rendered treatable, enabling patients maintain quality vision and subsequent improvement in quality of life

Ocular manifestation of systemic diseases with diabetes hypertension are also now treated with anti VEGF agents, with quality vision being restored and maintained.

 

What are the common conditions treated with anti VEGF agents and their benefits

 

Disease

Pathology

Benefits

Wet age related macular degeneration

Abnormal vessels at the back of the eye leak fluid and blood, leads to drop in vision

Abnormal vessels regress with resorption of fluids with subsequent improvement of vision

Diabetic macular edema

Leakage of fluid due at the back of the eye leading to swelling and vision drop

Prevent leakage and reduce swelling

Proliferative diabetic retinopathy

Abnormal vessels on the retina which bleed

Regression of abnormal vessels

Retinal vein occlusion

Swelling of retina due to obstruction of retinal blood vessels

Resolution of swelling with improvement of vision

 

How do I choose the type of anti VEGF agent

The doctor examining you will prescribe the appropriate agents as per the disease process and systemic illness. Active bleeding or fluid leak at the back of the eye called macula warrants urgent treatment. The doctor will perform appropriate scans to confirm, quantify and monitor the progress of the disease. Vision is measured and is one of the yardstick for monitoring response to treatment

 

How is the anti VEGF agent administered

  • After clinical examination and relevant scans and making a diagnosis the doctor will discuss the available options with the patient
  • The anti VEGF agent is administered into the eye by means of a fine needle under sterile conditions in an operation theater.
  • The eyes are numbed with topical anaesthetic agent
  • Cleaning of eyes and surrounding structures with antiseptic solution is done
  • Protective sheet called eye drape is applied around the eye
  • Eyelids are opened with a clip called eyelid speculum
  • The doctor injects the drug through the white part of the eye through a fine needle
  • After injection gentle massage is done at the site of injection
  • Eye clip is removed and antibiotic drops are instilled in the eye

Antibiotic drops are prescribed for usage after injection in the eye.

 

What are the anti VEGF agents available for treatment?

  • Bevacizumab
  • Ranibizumab
  • Aflibercept
  • Brolucizumab

 

Written by: Dr. Mohanraj – Consultant Ophthalmologist, Coimbatore

FAQ

Is the procedure painful?

The injection is done with a fine needle and mild pain which is well tolerated by most of the patients is there.

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