www.diabeticretinopathy.org.uk

Drugs to treat diabetic retinopathy

David Kinshuck

 

 

 

Anti-VEGF drugs

Anti-VEGF drugs

There are 3 drugs. Eylea is very slightly longer lasting. Avastin is the cheapest and almost certainly just as good as Lucentis which is in popular use.  The procedure is discussed.

The drugs reduce macular oedema (leakage in the cnetral retina) and proliferation (blood vessel growth) in diabetic retinopathy, but their effect usually wears off. To keep good sight in the long term, the diabetes, blood pressure (BP) and smoking must be controlled: the drugs are very useful for use whilst patients are trying to control their diabetes and BP targets

The risk of anti-VEGF treatment is small

How are Anti-VEGFs given

Months...Eye pressure

Renal Failure or Diamox allergies

Diamox is a drug given to lower eye pressure, and is used in a lower dose with renal failure, If this drug cannot be avoided, you must take precautions..as your your ophthalmic team may not realise you aware you have renal failure.

Pre-existing glaucoma

As intratvitreal steroids may put up your eye pressure, the treatment is  generally avoided in glaucoma patients. However, on most occasions the pressure rise can be treated, although rarely surgery is needed.

 

Repeated Anti-VEGF injections

Unfortunately the effect of these drugs is just weeks. Here is my interpretation of Macugen's (an older drug now withdrawn) results:

the benefits of macugen may be temporary

Visual acuity improved whilst the injections are given, but starts to deteriorate when they are stopped. However, if the blood pressure is lowered aggressively and diabetic control improves, ophthalmologists hope for much longer benefit.

 

Steroid injections

All these are injections in the eyeball itself, all with a risk of glaucoma. Triamcinolone is a regular fluid injection, Osardex and Iluvien are slow-release inserts.

 

Good control of diabetes

This is essential even with the new drugs. See targets