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Pregnancy Category: C
Pharmacologic: monoclonal antibodies
ClassificationTherapeutic: ocular agents
Pharmacologic: monoclonal antibodies
Neovascular (wet) age-related macular degeneration.Macular edema following retinal vein occlusion.Diabetic macular edema
Binds to vascular endothelial growth factor A (VEGF-A) receptor sites, preventing the binding of endogenous VEGF-A, resulting in decreased endothelial proliferation, vascular leakage and new vessel formation.
Decreased progression of visual loss.
Absorption: Intravitreal injection results in complete local bioavailability. Very low serum levels are achieved.
Metabolism and Excretion: Unknown.
Half-life: 9 days (intravitreal).
|intravitreal||unknown||after injection||1 mo|
Contraindicated in: Hypersensitivity; Ocular/periocular infections.
Use Cautiously in: Obstetric: Use only in pregnancy if clearly needed, use cautiously during lactation; Pediatric: Safety not established.
Adverse Reactions/Side Effects
Ear, Eye, Nose, Throat
- conjunctival hemorrhage (most frequent)
- eye pain (most frequent)
- ↑ intraocular pressure (most frequent)
- intraocular inflammation (most frequent)
- vitreal floaters (most frequent)
- retinal detachment
- arterial thromboembolic events (life-threatening)
Drug-Drug interaction↑ risk of serious intraocular inflammation with verteporfin.
Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly; after 4 mo, injections may be given every 1–3 mo.
Macular Edema Following Retinal Vein Occlusion
Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly.
Diabetic Macular Edema
Intravitreal (Adults) 0.3 mg (0.05 mL) once monthly.
Solution for intravitreal injection: 0.3 mg (0.05 mL)/vial, 0.5 mg (0.05 mL)/vial
- Assess eye for signs of infection frequently during week following injection.
- Check perfusion of optic nerve head immediately after injection, use tonometry to measure intraocular pressure prior to and 60 min following the injection.
Potential Nursing DiagnosesDisturbed sensory perception (Indications)
- Do not administer solutions that are discolored or contain particulate matter. Attach threaded plastic threader rod to the rubber stopper inside barrel of syringe. Do not pull back on plunger.
- Adequate analgesia and a broad-spectrum antibiotic should be given prior to injection.
- Intravitreal: For ophthalmic intravitreal injection only. Withdraw vial contents through a 5–micron gauge filter needle attached to a 1–cc tuberculin syringe. Discard filter needle after withdrawal. Replace filter needle with sterile 30–gauge x 1/2-inch needle for intravitreal injection. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe Each vial should be used for only one eye. If contralateral eye requires treatment, use new vial and equipment. Refrigerate solution and protect from light; do not freeze.
- Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.
- Slowing of vision loss.
ranibizumabA recombinant monoclonal antibody drug that inhibits the action of vascular endothelial growth factor (VEGF) protein and is believed to be useful in the treatment of age-related neovascular macular degeneration.
Drugs which bind to VEGF receptors without causing activation, thus blocking the production of new blood vessels and enhanced vessel permeability by the vascular endothelial growth factor (VEGF). They are used in the treatment of some forms of cancer (administered intravenously), and injected intravitreally in the treatment of choroidal neovascularization, retinal venous occlusion, and macular oedema. Examples: bevacizumab, pegaptanib sodium, ranibizumab. Syn. angiogenesis inhibitors. See age-related macular degeneration; diabetic retinopathy; VEGF.
macular degeneration, age-related (ARMD, AMD)
A common, chronic degenerative condition found in a large percentage of elderly patients (and sometimes middle-aged ones) characterized by loss of central vision. There are two main forms of the condition: non-neovascular (dry, atrophic) AMD, which is the most common, and exudative (wet, neovascular) AMD in which the loss of vision is the most severe. The main features of dry AMD are the presence in the macular region of small, yellowish-white spots (hard drusen) and large, poorly defined, coalescing soft drusen, focal hyperpigmentation of the retinal pigment epithelium (RPE) and at a later stage geographic atrophy of the RPE and depigmentation exposing choroidal vessels. Visual acuity becomes markedly reduced, there is metamorphopsia and the condition usually becomes bilateral over several years. The condition is managed essentially by the use of low vision aids.Exudative AMD has a similar clinical picture initially but is followed by choroidal neovascularization (CNV), which gives rise to subretinal fluid, haemorrhages, exudation, RPE detachment and subretinal fibrosis in the macular region resulting in severe loss of central vision. If detected early (usually with an Amsler chart), treatment with laser photocoagulation will reduce the risk of further visual loss. Photodynamic therapy (PDT) is another method of reducing the risk of visual loss. It allows selective destruction of the choroidal neovascularization with minimal damage to the overlying retinal tissue. It consists of injecting a photosensitizing agent (e.g. verteporfin) that is taken up by the abnormal vessels and when activated by a laser light of a given wavelength (e.g. 689 nm) it damages and shrivels up the vessels. Recent drug therapies, such as the anti-VEGF ranibizumab and bevacizumab, which are injected intravitreally at regular intervals and designed to stop the leakage and the growth of blood vessels, not only reduce loss of vision but improve visual acuity in a significant percentage of cases of wet AMD. Syn. senile macular degeneration. See fluorescein angiography; disciform scar; drusen; macular dystrophy; lipofuscin; age-related maculopathy; oxidative stress; macular pigment; Kollner's rule; photostress test; VEGF.