Treatment of AMD with Eylea and Lucentis

A person can suddenly lose sight and interrupt the most familiar and convenient connection with the outside world. The cause of this tragedy may be age-related macular degeneration. Ophthalmologists identify this dangerous disease as one of the most common eye diseases that can lead to vision loss. With timely treatment, injections of the drugs “Eylea” and “Lucentis” can cure this disease.

In what cases is the procedure performed?

If a person has difficulty blinking, is experiencing constant pain, and the drops do not have an effect, the ophthalmologist usually prescribes an injection into the eye. Such injections are made only by specialists; you should not administer the medicine yourself, as you can harm the organ even more. This procedure is performed with a very thin needle. The drug itself, the duration of the course and the number of injections are determined by the doctor, based on the specifics of the disease.

Ophthalmologists agree that intravitreal injection is an extremely effective way to treat eye diseases. This procedure helps well in stopping inflammatory processes, which, in turn, are of several types:

• uveitis;
• iridocyclitis;
• conjunctivitis.

In addition to inflammation, injections into the eye are prescribed for:

• mechanical damage to the organ;
• identifying blood clots in the retinal venous plexuses;
• macular degeneration, usually occurs in old age;
• retinal detachment, glaucoma and similar pathologies;
• astigmatism, atrophy, blepharitis;
• autoimmune pathologies (endocrine-type ophthalmopathy, rheumatoid arthritis, ankylosing spondylitis).

Types of injections

Experts distinguish several types of injections into the eyeball and classify them depending on how exactly the drug is administered.

1. Retrobulbar injection. A characteristic feature of this type of injection is the fairly deep insertion of the needle - about three centimeters into the marginal area of ​​the orbit. It is performed through the skin of the lower eyelid, parallel to the wall of the orbit of the eye. In this case, the drug enters the eyeball unhindered.
2. Subconjunctival injection. This method involves inserting a needle exactly under the conjunctiva in the lower eyelid area. The procedure is extremely painful and unpleasant; the injection is given only after the doctor instills pain-relieving drops. The manipulation is performed not once, but three times with an interval of one minute. For this type of injection, the doctor uses an insulin syringe.
3. Intravitreal injection. It is characterized by the introduction of medicine directly through the vitreous body with a very thin needle. Before starting the procedure, local anesthesia is performed.
4. Parabulbar injection. The parabulbar space is the fiber tissue that is located between the periosteum and the eyeball. The injection is made through the lower eyelid, the needle passes parallel to the lower wall of the orbit.

Contraindications

Contraindications depend on the type of drug and individual sensitivity to it.

It is not recommended to try to give injections at home or trust your health to friends, relatives and other people who do not understand anything about ophthalmology. The procedure can only be performed by a doctor or nurse.

Injections in the eyes are generally not recommended:

• pregnant women;
• breastfeeding;
• minors;
• those who have problems with the kidneys and liver.

But each case is individual, and the decision is made by the attending physician based on therapeutic goals.

What is the etiology of the development of macular degeneration?

Among the main causes, there are not only age-related factors that can cause vision loss, but when eliminated, the risks of loss of quality of life are reduced.

These factors include negative influence:

1. Smoking, which can increase the risk of developing the disease by 2 times, compared people of the same age;
2. An unbalanced diet, as a result of which the required amount of lutein and zeaxanthin does not enter the body, which reduces visual acuity, these pigments can be increased by increasing leafy vegetables, green peas, corn, broccoli in the diet;
3. Solar radiation, especially in the blue range of the spectrum, increases the level of load on the protective pigment, so it is recommended to use sunglasses in the summer season;
4. A separate risk group also consists of people with fair skin and blue eyes, as well as those with relatives who have AMD.

Which form of AMD is especially dangerous for humans?

Age-related macular degeneration is a chronic, progressive disease that causes degeneration of the retina and gradually leads to loss of central vision. The most dangerous is the so-called “wet” form of the disease, which can lead to irreversible blindness in just one year.

Timely consultation with a doctor allows you to stop the process of degeneration and, if possible, improve your vision functions. He prescribes treatment for age-related macular degeneration with modern drugs.

What medications are used to restore vision?

Treatment of the “wet” form of retinal AMD in Chelyabinsk is carried out in our clinic using a course of injection of the drugs “Lucentis” (Ranibizumab) and “Eylea” (Aflibercept) into the vitreous body (intravitreal injections). The drug "Lucentis" is produced by Novartis Pharma Stein AG in Switzerland, "Eylea" is produced by "Bayer Pharma AG" in Germany.

The drugs are created specifically for use in ophthalmology and are highly effective and safe. Prescribing Eilea and Lucentis injections can reduce macular edema, prevent hemorrhage and stop retinal damage. These drugs slow down vision deterioration in 70% of cases diagnosed with AMD, and can even improve the condition in 40% of patients.

Along with this disease, injections of Lucentis and Eylea are prescribed for the treatment of retinal vascular occlusion and diabetic macular edema.

What are the features of using Eylea and Lucentis injections?

At the Medinvest eye clinic, the effect of using Eylea and Lucentis injections has already been felt by many patients diagnosed with AMD who are undergoing treatment under the supervision of experienced specialists. It should be noted that during treatment:

• it is not always possible to restore full vision; the main purpose of the application is to stop the regressive process of macular degeneration and prevent the risk of complete blindness;
• The manifestation of the effect is observed within a few hours and is maintained for a month.

Whether Lucentis and Eylea injections should be used, and what treatment regimen should be used, is determined by the doctor on a case-by-case basis, based on a complete diagnostic eye examination.

How is retinal vascular occlusion treated?

Occlusion is characterized by impaired blood circulation in the central vessels of the retina and causes a sudden narrowing of the field of vision.

Treatment of the disease is carried out with the drug Ozurdex (micronized dexamethosone), produced by Allergan Pharmaceutical Ireland, Ireland. It is prescribed to patients with severe macular edema as a result of occlusion of the peripheral part and central vein of the retina.

If the swelling is not removed in a timely manner, the patient may completely lose vision. "Ozurdex" has a long-term anti-inflammatory effect, accumulates and acts within 180 days after administration. This significantly reduces macular edema and improves visual acuity in patients.

Preparations for injections into the eyes

Each type of disease requires treatment with the appropriate drug. It is prescribed by a doctor after a thorough examination and review of the patient’s medical record to identify individual characteristics.

Medicines for the eyes are divided into:

• antibiotics;
• vitamin complexes;
• hormonal;
• enzymatic.

One of the popular drugs is the Eylea solution, which is produced in Italy. It is actively used to treat diseases of the organs of vision. But, besides this, there are several more effective remedies that have proven themselves and are actively used by ophthalmologists.

Antiangiogenic therapy using Avastin and Lucentis

To prevent the formation of new microvessels from existing capillaries, antiangiogenic therapy is carried out, during which Avastin is often used. This drug belongs to the class of antitumor drugs. It blocks proliferation processes and helps stop the growth of fresh blood vessels. In addition, it perfectly fights the causes of the disease. Often this phenomenon is caused by pathologies such as the wet form of macular degeneration in older people, diabetic retinopathy, and so on.

The main active chemical in Avastin is bevacizumab. It is this substance that, when penetrating the protein, helps stop tissue proliferation and blocks the growth of a tumor, if there is one.

The ophthalmologist injects the drug into the vitreous body, the direction of play is towards the central sections. The dose is 1.25 mg. The composition must be administered once a month. The course consists of several injections. More than 60% of patients note stabilization of vision after treatment.

An analogue of this drug is the no less famous “Lucentis”. It has the same functions and action. The only difference between the two drugs is that the active chemical in Avastin is bevacizumab, while in Lucentis it is ranibizumab. But both drugs have the same effect on the body, indications and contraindications, which include pregnancy, breastfeeding and problems with the kidneys and liver.

Both drugs are rated as effective and consistently show excellent results. But numbers speak better than words. Statistics on the use of these drugs show that 92% of patients treated with Avastin or Lucentis retained their vision. And in 70% of patients it even worsened after taking Lucentis. Those treated with Avastin performed even better – vision improved by an average of 1.9 letters.

"Pheebs"

This medicine is created on the basis of biogenic stimulants. Thanks to this, “Phibs” increases the speed of regeneration and improves metabolic processes. It is used in the treatment of various diseases:

• inflammatory processes in the cornea and at the edges of the eyelids;
• different types of conjunctivitis;
• diseases causing vision loss;
• vitreous opacification.

The active chemicals in this drug are extracts of estuary mud, cinnamic acid and coumarin.

Contraindications to the use of "Phibs":

• problems with the heart and blood vessels;
• diseases of the gastrointestinal tract;
• pregnancy;
• lactation period;
• kidney problems.

The course of treatment usually lasts for a month or a little longer. The specialist administers the drug once a day. A repetition of the course, if necessary, can be scheduled only two months after the first.

"Ozurdex"

The drug is in the form of an implant. It contains the hormone dexamethasone and other excipients: a copolymer of lactic and glycolic acid.

Dexamethasone is a potent corticosteroid, therefore it is extremely effective in combating inflammatory processes, has an anti-edematous effect, prevents the growth of new blood vessels, thickens the walls of capillaries and the activity of fibroblasts. In addition, this substance shows excellent results in the fight against retinal vein occlusion and helps restore blood circulation in the capillaries.

The statistics of treatment with this drug are convincing: in most patients, the thickness of the retina decreased by two or more times, which brought it closer to normal, and visual acuity increased from 5% to 65%.

But such an effective medicine has its contraindications:

• individual intolerance;
• trachoma;
• glaucoma;
• various types of infections - from bacterial to viral.

"Reaferon EU"

This is an immunomodulatory drug that effectively fights tumors and viruses. Stops the reproduction of viruses in infected cells. Used in treatment if the patient:

• conjunctivitis;
• uevitis;
• inflammation of the outer membrane and cornea of ​​the eye.

The main active substance is interferon alpha 2a, which contains 165 amino acids.

The course usually consists of 15-20 injections, but the final decision on the treatment regimen is made by the attending physician. Injections are given daily.

It is not recommended for use by people who have:

• kidney and liver problems;
• heart diseases;
• pregnancy and lactation;
• mental disorders.

The drug is also contraindicated in people who are already taking immunosuppressive medications.

"Emoxipin"

This drug has a potent effect. Shows excellent results in the treatment of:

• cataracts;
• pathologies of the vascular system of the eyes;
• oxygen starvation;
• glaucoma;
• keratitis;
• damage to the cornea of ​​the eye.

The main active chemical substance is methylethylpyridinol hydrochloride, thanks to which “Emoxipin” exhibits the properties of an antioxidant, antihypoxant, vasoconstrictor and antiplatelet agent. This means that the medicine reduces the number of free radicals that have a bad effect on the body, increases resistance to oxygen deficiency, makes blood vessels stronger and less permeable, and prevents the formation of blood clots.

The specialist administers this drug under the conjunctiva, retrobulbar or parabulbar.

Contraindicated in people who are already taking other medications, have an individual intolerance to the drug, or are pregnant or breastfeeding.

Silmalaser

Patients with macular edema or neovascularization due to wet age-related macular degeneration, diabetes mellitus, retinal vein thrombosis, or certain other eye diseases may need intraocular injections.

During the intraocular injection procedure, a medicine is administered into the eye that works against swelling and the formation of new blood vessels, reducing the amount of substances in the eye that cause the above-mentioned changes.

Repeated intraocular injections are often required because macular edema and neovascularization return and vision deteriorates after the drug wears off. Monitoring for the presence of edema can be done using an OCT (optical coherence tomography) study. The retina of the eye is photographed layer by layer, which makes it possible to very accurately assess the condition of the retina and the presence of edema. The examination takes approximately 5 minutes and does not require any preliminary preparation of the patient.

Depending on the eye disease causing vision loss, anti-VEGF drugs (medicines against endothelial growth factor (inner wall) of blood vessels) or synthetic corticosteroid drugs are used as intraocular injection medications. Rarely, a combination of both drugs may be required.

In all studies conducted, the anti-VEGF drug demonstrated its effectiveness. Several similar drugs can be used for treatment.

Lucentis is a registered eye medicine. The active ingredient in Lucentis is ranibizumab, which is a humanized recombinant monoclonal antibody fragment (a specific protein) that is directed against human vascular endothelial growth factor (VEGF). VEGF levels are high in patients with the above diseases. Blocking the factor reduces the growth of new blood vessels and reduces macular edema.

Avastin , the active substance of which bevacizumab, is also a monoclonal antibody (a certain protein) that recognizes a specific structure (antigen) existing in individual cells or in the blood and binds to it. Bevacizumab binds to vascular endothelial growth factor (VEGF). VEGF is a factor present in the blood circulation that promotes the growth of blood vessels. By binding to VEGF, Avastin blocks the action of the factor and inhibits the growth of new blood vessels (neovascularization).

Avastin is not currently registered as an eye medicine in Estonia. However, the medicine has been used for more than 7 years, and the treatment results in all studies conducted are good. The medicine is used in the form of the so-called. the drug is “off label” - this means that the medicine is used in medicine, but the drug is not registered as an eye medicine. The effectiveness and sufficient safety of the drug have also been proven. The medicine can be used if the patient is previously informed about this and has given his consent to the use of the medicine.

Eylea is a registered ophthalmic drug whose active ingredient, aflibercept, is a recombinant fusion protein that binds to vascular endothelial growth factor (VEGF) and placental growth factor (PIGF). As a result, the process of neovascularization in the eye is inhibited, and swelling of the macula (macula) decreases.

Synthetic corticosteroids for intraocular injections include Ozurdex and Kenalog.

Kenalog, whose active ingredient is triamcinolone, is a synthetic corticosteroid with a strong anti-inflammatory effect. To a small extent, the drug also has an anti-VEGF effect. Solutions of varying strengths are used. Used mainly in cases of extensive macular edema. Triamcinolone may cause increased intraocular pressure and the development of cataracts. Usually, to normalize intraocular pressure, the use of eye drops that reduce intraocular pressure is sufficient. Kenalog is not registered as an eye medication. In all studies conducted, the drug was effective.

Ozurdex, the active ingredient of which is dexamethasone, is a synthetic corticosteroid with a strong anti-inflammatory effect and, to a small extent, also an anti-VEGF effect. Ozurdex is a registered ophthalmic drug used primarily to reduce macular edema due to venous thrombosis and macular edema due to intraocular inflammation. Recent studies show that the drug can also be successfully used in the treatment of macular edema caused by diabetes. Side effects of the drug: increased intraocular pressure and the development of cataracts, however, these side effects are less pronounced than in the case of Kenalog.

The intraocular injection procedure is performed by an eye doctor in a sterile operating room on an outpatient basis; inpatient treatment is not required. The pupil is dilated using appropriate eye drops, the effect of which occurs within 20-30 minutes. The procedure itself is painless; anesthetic eye drops are used to numb the eye. The required amount of medication is injected through an ultra-thin syringe needle into the inside of the eye into the vitreous cavity. Immediately after the injection, eye drops with an antibacterial effect are instilled into the eye. At home, you need to use anti-inflammatory eye drops for a week. After the procedure, your visual acuity is impaired for up to 12 hours.

After intraocular injection, minor redness and irritation of the eye may occur. All these symptoms will go away within a few days. Black spots and dots may often appear before the eyes. This is caused by clouding of the vitreous body and is not dangerous.

The following complications associated with injections are also possible:

• severe inflammation of the eye (endophthalmitis)
• retinal tear and detachment
• hemorrhage into the vitreous body of the eye
• mechanical damage to the lens
• increased intraocular pressure

These complications must be treated with additional procedures and surgeries. If your eye begins to hurt or your vision begins to deteriorate sharply, you should immediately consult an eye doctor.

Preparation and carrying out the procedure

When preparing and performing injection manipulation, it is important to follow the following rules.

1. Before the procedure, the eyeball is thoroughly anesthetized, usually with novocaine or dicaine in the form of eye drops. After five minutes, you can begin to administer the drug.
2. Intravitreal injections into the eye are performed only by an experienced ophthalmologist using disposable instruments.
3. When performing the procedure using subconjunctival, retrobulbar or parabulbar methods, it is necessary to treat the area where the needle will be inserted with a 70% solution of ethyl alcohol.
4. After the procedure is completed, the patient needs to press a cotton swab soaked in an antibacterial solution for several minutes.

How to give an injection

The order of the injection procedure depends on how exactly the drug will be administered. But, in any case, all this will happen in strictly sterile conditions on an outpatient basis.

The doctor dilates the pupil with special drops; they begin to act after 20-30 minutes.

Visual acuity will remain reduced for another 12 hours after the end of the procedure.

The needle is inserted either into the edge of the orbit, or with a cut towards the eyeball, or near the limbus, or into the sub-Tenon's space. It all depends on the disease and the purpose of the injection. This is decided only by the attending physician.

What drugs are used for intravitreal administration?

The most commonly used drugs for administration into the eye cavity are Lucentis, Ozurdex, Kenalog, Aylia and Gemaza. Antibacterial drugs can also be used for intravitreal administration.

The drug Lucentis is used to treat the wet form of age-related macular degeneration (AMD), as well as in patients with neovascular membrane (due to previous inflammation of the eye, high myopia, etc.), diabetic retinopathy, and occlusions of the central retinal vein. The action of the drug Lucentis is aimed at preventing the growth of abnormal defective vessels and associated complications in the form of multiple hemorrhages in the eye cavity, retinal detachment and loss of vision. In most cases, although not 100% of cases, Lucentis helps stop the progression of visual acuity deterioration and prevent blindness. For the same purpose, intravitreal administration of the drug Aylia is used.

Ozurdex is a drug used to treat macular edema. The dosage form of the drug Ozurdex - an implant developed for intravitreal administration - ensures long-term preservation of the therapeutic effect. Thanks to this, a prolonged, powerful anti-inflammatory and anti-edematous effect is achieved, which contributes to long-term improvement of vision.

Kenalog is a glucocorticosteroid for intravitreal administration that has an inhibitory effect on all phases of the inflammatory process in the eye cavity. In ophthalmology, the drug is used for administration parabulbarly and into the sub-Tenon's space. Kenalog is characterized by a prolonged therapeutic effect and the absence of a systemic effect on the body.

Gemaza in the form of intravitreal injections is used to treat occlusion of the main vessels of the retina, hemorrhage in the eyeball (hemophthalmos, hyphema) and in the retinal area, adhesions after surgical treatment of glaucoma. The drug provides fibrinolytic and thrombolytic effects.

The cost of intravitreal injections, and where you can undergo the procedure

The procedure can be carried out after a thorough examination by a specialist and diagnosis of the disease at an ophthalmology center. To establish a diagnosis, you will have to undergo several tests, which will be prescribed by an experienced doctor.

The procedure described is not cheap. The injection itself costs 200-300 rubles, excluding the price of the drug. And with it, the amounts range from 10,000 to 70,000 rubles. It all depends on the medical center, the qualifications of the doctor and the drug itself.

But health is always worth its money, you just need to trust the professionals, because our eyes help us see this wonderful world, our loved ones, do important things and just enjoy. They are the most important sensory organ that requires timely treatment and care.