Comm Eye Health Vol. 27 No. 87 2014 pp 45. Published online 10 December 2014.

Use of anti-VEGF drugs at the Instituto de la Visión de Montemorelos

Pedro A Gomez Bastar

CBM Medical Adviser and Chairman, Instituto de la Vision, Universidad de Montemorelos, Mexico pgomez07@gmail.com

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Anti-VEGF injections are given in a clean room. Image credit: Pedro A. Gomez Bastar
Anti-VEGF injections are given in a clean room. Image credit: Pedro A. Gomez Bastar

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.