Intravitreal Injection of Avastin v2

Intravitreal Injection of Avastin

Patient Information

Ophthalmology Department - Boston House Eye Unit

• Author ID:           PP
• Leaflet Ref:         Ophth 019
• Version:              2
• Leaflet title:         Intravitreal Injection of Avastin
• Last review:        August 2022
• Expiry Date:        August 2024

Introduction

Avastin^TM is an anti-growth factor drug used to reduce eye complications in diabetes, retinal vein blockage or other macular diseases.

Retinal damage releases a chemical, VEGF (VEGF= vascular endothelial growth factor) which causes adjacent retina to leak or grow 'new blood vessels’.

Avastin^TM blocks the effect of VEGF by binding to the VEGF receptors on the cells in the retina.  This then reduces the leakage, and the sight may improve.

A second effect of the VEGF is to make tiny blood vessels grow.  These new vessels are very delicate and very easily bleed, and this blood can damage your eye.  This is 'proliferative retinopathy'.  Laser is the main treatment, but Avastin^TM is a new treatment that will generally be used in addition to laser.

When the blood vessels grow in the drainage meshwork, the aqueous humour (a watery fluid) produced in the eye cannot drain away.  This leads to a very high pressure in the eye, called rubeotic glaucoma.  Avastin^TM is an excellent treatment for this, but the effect may be temporary.  Laser is usually needed as soon as the pressure has dropped.

Aims

In the UK, Avastin^TM is not licensed, which means that it has not yet been approved by the NHS. 

However, Ophthalmologists are using Avastin^TM “off-label” to treat conditions where research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. 

The Procedure

Intravitreal Avastin^TM (here called IVA) is an injection of the anti-VEGF drug Avastin^TM into the vitreous cavity( in the fluid at back of the eye) of your eye.

IVA is given as an injection usually in a clean minor surgery room.  The injection procedure itself takes seconds and is usually feels like a tiny prick.  You can go home later that day - this is a 'day case' procedure.

Risks

About 1/1000 people will develop a serious eye infection.  If your eye starts to get red, with misty vision (there may be no pain), perhaps 2-5 days after the injection, you should suspect an infection and attend the eye department urgently.

There is a 1% risk of a retinal tear after this injection.  Please seek attention (within 24 hours, the next day is usually OK) from an ophthalmologist if you develop the symptoms of a tear, a sudden shower of floaters and flashes of light.  These may happen in the months after the injection. 

There is a very small chance that the drug will cause side effects outside the eye, such as aggravating heart disease, but no extra risk was found in a large safety survey.

Benefits

Many people will notice some improvement in vision.  The macular oedema reduces, with a maximum reduction at 2 weeks, and starts to wear off after 3 months.  It gives a chance for laser treatment and lower blood pressure etc., to have their effect.  Further injections may be needed. 

Complications when Avastin is given to patients with cancer

When Avastin^TM is given to patients with metastatic colorectal cancer, some patients experienced serious and sometimes life-threatening complications, such as gastrointestinal perforations or wound healing complications, haemorrhage, arterial thromboembolic events (such as stroke or heart attack), hypertension, proteinuria, and congestive heart failure. Patients who experienced these complications not only had metastatic colon 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. 

Treatment procedure and after care

Refer to leaflet Ophth 012 Anti-VEGF Injection Treatment available on the trust website, copy and paste the following link into your browser, or scan the QR code. https://www.wwl.nhs.uk/leaflets/download/wwl-5ff331883f2ae6.97151025

Contact telephone numbers

Ophthalmic Department, Boston House Eye Clinic

Monday to Friday, 9am to 5pm 01942 822244 

If you have any difficulty getting through on these numbers, contact:

Royal Albert Edward Infirmary Switchboard: 01942 244000.

Outside of the Boston House Eye Clinic opening times, please attend the Accident and Emergency Department, Royal Albert Edward Infirmary, telephone: 01942 244000 and ask for Accident & Emergency.