Intravitreal Avastin

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. There are two types of macular degeneration: dry and wet. In the “wet” form, 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.

Refractory macular edema (patients who have failed prior standard treatment such as laser photocoagulation), or swelling around the macula 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 could progress and become permanent.

Avastin was not initially developed to treat eye conditions. Based upon the results of clinical trials that demonstrated its safety and effectiveness. Avastin was approved for the treatment of metastatic colorectal cancer. Avastin works by blocking a substance known as vascular endothelial growth factor (VEGF). Blocking or inhibiting VEGF helps to prevent further growth of blood vessels that the cancer needs to continue growing.

Ophthalmologists are using Avastin to treat AMD and similar conditions since research suggests that VEGF stimulates the growth of the abnormal vessels that causes these conditions. Health Canada has not approved Avastin for treatment of any eye disease; therefore the cost is not covered by medical services plan. The goal of treatment is to prevent any further vision loss. Although some patients have regained vision, the medication may not restore vision that has already been lost, and may not prevent further loss of vision.

Administration
After the pupil is dilated the eye is numbed with anaesthesia, antiseptic consisting of iodine drops are administered, and then Avastin is then injected into the vitreous or jelly-like substance in the back chamber of the eye.

Alternatives
You do not have to receive the treatment for your condition, although without treatment, these diseases can lead to further vision loss and blindness, sometimes very quickly. At present, there are two FDA-approved treatments for your condition: photodynamic therapy PDT) with a drug called Visudyne & Macugen-an injection into the eye. Although both of these treatments have been proven to slow down the rate of visual loss, most people do not gain any vision. Lucentis, an experimental drug very similar to Avastin (but developed for the eye) is in its final stages of study.

Risks with Avastin
The benefits and risks of intravitreal Avastin for eye conditions are not yet fully known, as there have been no careful studies of Avastin given into the eye.

Known risks of intravitreal eye injections
Your condition may not get better or may become worse. Any or all of these complications may cause decreased vision and/or have a possibility of causing blindness. Additional procedures may be needed to treat these complications.

Any medication has the potential to cause allergic reactions in a small number of people.

Possible complications and side effects of the procedure and administration of Avastin include but are not limited to retinal detachment, cataract formation, glaucoma, hypotony, damage to retina or cornea, and bleeding. There is also the possibility of an eye infection. You may receive drops to reduce the possibility of infection. Any of these rare complications may lead to severe permanent vision loss.

Some patient may experience side effects related to the pre-injection preparations including: eye pain, subconjuctival hemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the cornea, inflammation of the eyelid, and visual disturbance.

Follow-up
You will follow-up with Dr. Hopp 6-8 weeks after the injection, unless you develop pain, decreased vision or redness in the eye.