LUCENTIS® (Ranibizumab) INJECTION
FOR WET AGE RELATED MACULAR DEGENERATION
Wet Age Related Macular Degeneration (ARMD) is a medical condition which causes
damage to the centre of your vision.
Without treatment there is a 60% chance of significant visual loss in the affected eye within 2
years. There is approximately a 6%-10% chance of the other eye being affected with wet
age related macular degeneration each year.
It is not known why some people get it and others do not. However, it is more common the
older you are, if you are female and smokers are at particularly high risk of visual loss.
There is also a genetic predisposition (if someone in the family also has ARMD) but this does
not account for all cases.
A diet high in green leafy vegetables (kale, broccoli etc) is advisable. If you have lost vision
in one eye from ARMD then there may be some benefit in taking specific vitamins to reduce
the risk of visual loss in the second eye. Please ask your ophthalmologist for advice.
What is going wrong with my eye?
An abnormal clump of blood vessels has started to grow in the wrong place forming a lump
underneath the retina. The retina is a bit like wallpaper lining the inside of the eyeball. It is
made up of light sensitive cells which are very delicate and easily damaged. The retina is
essential for normal vision.
The clump of abnormal blood vessels leak under the retina, this sometimes creates a blister
of fluid. This causes the early symptoms of distortion of straight lines when you look directly
at them. Untreated the leakage gets worse and the blood vessels start to bleed and form a
lump of scar tissue, or sometimes the blister bursts. Both these mechanisms contribute to
permanent loss of central vision.
How might my vision be affected?
In the early stages you may notice that straight lines look bent or distorted. In the later stages
there may be a black patch over the centre of your vision which you cannot see through.
The condition will only affect the centre of your vision but this is the important part of your
vision for reading, watching TV, recognising faces and doing any sort of detailed visual task
like knitting.
How do Lucentis® injections work?
Lucentis® is an anti-VEGF agent (anti-vascular endothelial derived growth factor). This
means that it acts as a chemical signal to the clump of abnormal blood vessels behind the
retina and tells them to stop leaking fluid and to shrink away. Although it does not work in
every patient it is extremely effective.
90% of patients maintain the vision they had when they started treatment over a two year
period.
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30% of patients have considerably improved vision; being able to read 3 more lines on the
eye test chart (statistical information taken from the MARINA and ANCHOR studies).
How is the Lucentis® injection given?
You will be asked to sign a consent form before you have the injection and your doctor will
explain to you the procedure, the risks and benefits of the injections and if there are any
alternative treatments you could have.
Before each injection your doctor will ask you to use antibiotic eye drops four times a day for
three days to prevent any possible eye infection.
To reach the clump of abnormal blood vessels the Lucentis has to be injected into the
eyeball. This is done in a clean room or operating theatre. The procedure will take around
15 minutes, however, you will need to stay with us for around 1 – 2 hours altogether.
Your pupil will be dilated with some eye drops. When you are ready, you will go into the
theatre (in your own clothes) and your eye will be numbed (anaesthetised) with drops.
You lie down on a trolley and we put an iodine solution on the surface of your eye to kill off
any bacteria. Antibiotic eye drops are also used to keep the eye as sterile as possible before
the injection.
A sterile drape is stuck over the eye and a clip is used to keep your eyelids open during the
injection.
The injection passes through the white bit of the eye so you shouldn’t see the needle coming
towards you. Although you can feel some sensation it is well tolerated and similar to a blood
test in terms of discomfort.
You will then return to the ward and be seen by the nurse who will check that you are well
enough to go home after around 45 minutes and will make sure you have some antibiotic /
anti-inflammatory drops to use. You will have an appointment to come back to clinic in 1 – 2
weeks.
Are there any side effects or risks of the injection?
Common side effects (occurring at a rate of around 1 per 10 injections) include mild blurring
of vision for a day or so after the injection. Often a small blood vessel on the outside surface
of the eye is burst during the injection. This makes the white part of the eye look bright red
but it is not painful and gets better without any treatment within a week or so.
The eye may feel gritty for a day or so after the injection. You may also notice a temporary
increase in the number of floaters that you experience.
Serious side-effects include infection, which occurs at a rate of about 1 per 1000 injections.
Infection inside the eye often leads to blindness so we take extensive precautions to avoid
this happening. Infection causes a painful (severe ache), red eye with a rapid reduction in
vision.
If you are worried that you may have an infection in the eye following an injection you should
telephone 01536 492153 or 01536 492105 Monday – Friday 8.30am – 4.30pm (except
public holidays)
Author: Laura Young, senior sister, Ophthalmology
Ref: 10.PI.0461 April 2009
Next review April 2011
www.kgh.nhs.uk
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To be seen out of hours or during the weekend you will need to attend the Accident and
Emergency (A&E) department at Northampton General Hospital.
Telephone 01604 634700 and ask for the Junior Eye Doctor on call who will contact the on
call ophthalmologist for advice. Please present this leaflet to the A&E nurse or receptionist
for their information.
Other side-effects can include the formation of cataract or retinal detachment. Current
research suggests that the rates of this happening are around 1 per 100 injections. Again, if
you notice a sudden deterioration in your vision then contact us on the number above.
Risks to your general health include a small chance of increased blood pressure and a slight
increase in the risk of bleeding such as nose bleeds or very rarely a stroke.
How many injections will I need?
Unfortunately the injections seem to wear off after a few weeks to months and therefore
need to be repeated.
Current practice is to give everybody one injection every month for the first three months and
then to only give more injections if there is still evidence of leaking blood vessels at the back
of the eye.
These indications for re-treatment will probably change as more research studies are done
using Lucentis®. In practice most patients will require 8 injections in the first year of
treatment and 6 in the second year. Some patients will stabilise and not need further
injections whilst others will still need an injection every month even after two years.
Post procedure advice
You will need to instil the following antibiotic and anti inflammatory eye drops
Maxitrol® drops
Acular® drops
6 times a day for one week, then 4 times a day for one week.
3 times a day for 2 weeks
You will also need to take Diamox® tablets (1 tablet (250mg) twice a day for 2 days)
This is to stop you getting any infections in the eye.
You should not go swimming for 5 days after the injection.
Do not rub the eye for at least 5 days after the injection.
References
Emc.medicines.org.uk
Lucentis
www.tanner-eyes.co.uk ……..Anti VEGF agents
www.macular-disease.org
Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. National Institute of Health
and Clinical Excellence. August 2008
Author: Laura Young, senior sister, Ophthalmology
Ref: 10.PI.0461 April 2009
Next review April 2011
www.kgh.nhs.uk
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