Intra-vitreal Injections

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. It is caused by the breakdown of the central portion of the retina called the macula. This is the nerve layer part of your eye that works like the film in a camera to pick up the picture. 

The macula is responsible for the fine central vision in the eye that is needed for driving a car, reading fine print, recognizing faces, etc. There are two types of macular degeneration: dry and wet. In the “wet” form of AMD, abnormal blood vessels grow in the back of the eye. Sometimes these vessels leak blood or fluid that causes blurred or distorted vision. Without treatment, vision loss may be quick and severe.

There are other eye conditions that cause loss of vision due to abnormal growth of blood vessels in the back of the eye. These can occur even in young patients, and include, but are not limited to, conditions such as high myopia (short-sightedness), and eye injury. Sometimes there is no known reason for the abnormal blood vessels. Without treatment, vision loss may be quick and severe.

Refractory macular oedema, or swelling around the macula, is oedema that affects vision but does not respond adequately to the usual treatment methods. It can occur with conditions such as central retinal vein occlusion and diabetic retinopathy. Without effective treatment, vision loss may progress and become permanent.

POSSIBLE BENEFITS AND “OFF-LICENCE” STATUS:

Avastin was not initially developed to treat your eye condition. Based upon the results of clinical trials that demonstrated its safety and effectiveness, Once a device or medication is licensed by the government, physicians may use it “off-licence” for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using Avastin “off-licence” to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin had less fluid and more normal-appearing maculas, and their vision improved. Avastin is also used, therefore, to treat macular oedema, or swelling of the macula.

POSSIBLE LIMITATIONS AND ADMINISTRATION:

The goal of treatment is to prevent further loss of vision. Although some patients have regained vision, the medication may not restore vision that has already been lost, and may not ultimately prevent further loss of vision caused by the disease. After the pupil is dilated and the eye is numbed with anaesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. Avastin is administered by an injection into your eye as needed at regular intervals (about every six to eight weeks); your ophthalmologist will tell you how often you will receive the injection, and for how long. The majority of people with wet AMD need a number of – or even continuous treatments.

ALTERNATIVES:

You do not have to receive treatment for your condition, although without treatment, these diseases usually cause further vision loss, sometimes very quickly. Other forms of treatment are available. At present, approved treatments for neovascular age-related macular degeneration include injection into the eye of drugs called Eyelea or Lucentis. These treatments are available through Jersey Health and Social Services.  Here, in Jersey the first type of Anti-vegf used for the majority of patients is Avastin .Your doctor will discuss with you the benefits and risks associated with these various treatments. In addition to the approved medications, some ophthalmologists use intravitreal Kenalog - a long-acting cortisone-like drug - “off-licence” to treat eye conditions like yours.

POSSIBLE COMPLICATIONS FROM THE MEDICATION AND INJECTION:

Complications when Avastin is given to patients with cancer:

When Avastin is given to patients with bowel cancer, some patients experienced serious and sometimes life-threatening complications, such as gastrointestinal perforations or wound healing complications, haemorrhage, arterial thrombo-embolic events (such as stroke or heart attack), hypertension, urinary problems, and congestive heart failure. Patients who experienced these complications not only had bowel cancer, but were also given 400 times the dose you will be given, at more frequent intervals, and in a way (through an intravenous infusion) that spread the drug throughout their bodies.