Macular Degeneration - Avastin or Lucentis
Injections of medications such as Avastin or Lucentis into the eye has become common in the treatment of wet aged-related macular degeneration (ARMD). Naturally, patients are somewhat apprehensive when this treatment is offered, but it is actually very well tolerated. The procedure is done in the office and has a rapid recovery time. Antibiotic drops will be prescribed after the procedure. At the time of the procedure, the surface of the eye is anesthetized using lidocaine eye drops. Also, a cotton swab soaked in lidocaine may be placed under the eyelid at the site of the injection to anesthetize the eye ensure minimal discomfort. An anesthetic injection may also be performed to ensure minimal discomfort. The eye is cleaned with an antiseptic solution, and a small wire speculum used to hold the eye open during the procedure. Most patients have no discomfort during the procedure. Later in the day, as the anesthetic wears off, there is some pain or scratchy sensation, which usually lasts for a day or so. The eye may appear red for several days due to superficial bleeding.
Avastin (Bevacizumab injection) is not FDA approved for treatment of wet ARMD wet. The FDA has only approved Avastin for treatment of metastatic colorectal cancer. However, recently several small clinical series using intravtireal Avastin for the treatment of wet ARMD have been reported. These studies show such promising results, that Medicare and some private insurance companies have approved Avastin for coverage of this condition. There have also been some reports of improvement of visual acuity or was visual acuity was maintained, reduction in retinal thickening as detected from OCT, and no marked short-term toxicity. Overall, the patients that were treated with Avastin in the short-term studies did appear to benefit from the injections.
Lucentis (Ranibizumab injection) is indicated for the treatment of wet ARMD. In June 2006, the FDA approved Lucentis for the treatment of wet ARMD. The FDA approval of Lucentis is based on data from two large Phase III clinic trials and one Phase IIIb study. These studies showed patients' visual acuity improved or was maintained. Lucentis is designed to bind and inhibit VEGF-A, a protein that is believed to play a critical role in the formation of new blood vessles. In wet ARMD, these blood vessels grow under the retina and leak blood and fluid causing rapid damage to the macula, the portion of the eye responsible for fine, detailed central vision.
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