Indications: ranibizumab are vascular endothelial growth factor inhibitors licensed for the treatment of neovascular (wet) age-related macular degeneration. Aflibercept is also licensed for the treatment of macular oedema secondary to central retinal vein occlusion; ranibizumab is also licensed for the treatment of visual impairment due to diabetic macular oedema, macular oedema secondary to branch or central retinal vein occlusion, and choroidal neovascularisation secondary to pathologic myopia. Ranibizumab can be administered concomitantly with laser photocoagulation for the treatment of diabetic macular oedema and for macular oedema secondary to branch retinal vein occlusion. They are given by intravitreal injection by specialists experienced in the management of this condition. There is a potential risk of arterial thromboembolic events and non-ocular haemorrhage following the intravitreal injection of vascular endothelial growth factor inhibitors. Endophthalmitis can occur after intravitreal injections— patients should be advised to report any signs of infection immediately.

Cautions: history of stroke or transient ischaemic attack; patients at risk of retinal pigment epithelial tear; monitor intra-ocular pressure, perfusion of the optic nerve head, and for signs of ocular infection following injection; retinal detachment or macular hole—discontinue treatment if rhegmatogenous retinal detachment or stage 3 or 4 macular hole develops; diabetic macular oedema due to type 1 diabetes (limited information available); previous intravitreal injections; active systemic infection; proliferative diabetic retinopathy; uncontrolled hypertension; diabetic patients with HbA1c over 12% Contra-indications: ocular or periocular infection; severe intra-ocular inflammation; signs of irreversible ischaemic visual function loss in patients with retinal vein occlusion.

Pregnancy: manufacturer advises avoid unless potential benefit outweighs risk and recommends women use effective contraception during and for at least 3 months after treatment.

Breast-feeding: manufacturer advises avoid—no information available

Side Effects: nausea, headache, nasopharyngitis, cough, anxiety, anaemia, urinary tract infection, arthralgia, raised intra-ocular pressure, visual disturbance, conjunctival, retinal, and vitreous disorders, ocular discomfort, eye haemorrhage, uveitis, iritis, blepharitis, iridocyclitis, cataract, posterior capsule opacification, punctuate keratitis, anterior chamber flare, conjunctivitis, photopsia, photophobia, eyelid oedema, allergic skin reactions; less commonly blindness, hypopyon, hyphaema, keratopathy, corneal disorders, iris adhesion.

Dose: Neovascular (wet) age-related macular degeneration, by intravitreal injection, ADULT over 18 years, 500 mcg once a month into the affected eye; monitor visual acuity monthly; continue treatment until visual acuity is stable for 3 consecutive months; thereafter monitor visual acuity monthly; if necessary subsequent doses may be given at least 1 month apart.

Diabetic macular oedema, macular oedema secondary to retinal vein occlusion, by intravitreal injection, ADULT over 18 years, 500 mcg once a month into the affected eye; monitor visual acuity monthly; continue treatment until visual acuity is stable for 3 consecutive months (discontinue treatment if no improvement in visual acuity after initial 3 injections); thereafter monitor visual acuity monthly; if necessary subsequent doses may be given at least 1 month apart.

Choroidal neovascularisation secondary to pathologic myopia, by intravitreal injection, ADULT over 18 years, initially 500 mcg as a single injection into the affected eye; monitor for disease activity monthly for first 2 months, then at least every 3 months thereafter during the first year, then as required; if necessary subsequent doses may be given at least 1 month apart.

Concomitant treatment of diabetic macular oedema, or macular oedema secondary to branch retinal vein occlusion, with laser photocoagulation, by intravitreal injection, ADULT, 500 mcg at least 30 minutes after laser photocoagulation.