Bevacizumab (Intravitreal)

How it works

It binds and neutralises all isoforms of vascular endothelial growth factor A, suppressing the abnormal choroidal and retinal neovascularisation and vascular leakage that cause macular oedema and visual loss.

Prescribing in practice

• Strict aseptic intravitreal injection technique is essential, as endophthalmitis is a sight-threatening complication; warn the patient to report increasing pain, redness or visual loss urgently.
• Use in the eye is off-label (the licensed indication is oncology), so local governance, informed consent and compounding from a quality-assured source are required.
• Avoid in active ocular or periocular infection and counsel that a transient rise in intraocular pressure can follow injection.

Monitoring

Monitor intraocular pressure and optic nerve perfusion around the time of injection and review retinal status with optical coherence tomography and visual acuity at each follow-up.

Counselling the patient

• Report any eye pain, worsening redness, light sensitivity or sudden drop in vision after injection without delay.
• Floaters and mild irritation are common in the first day or two and usually settle.
• Attend all scheduled review and re-treatment appointments to protect your vision.

Evidence & guidelines

Comparative trials such as CATT and IVAN found intravitreal bevacizumab non-inferior to ranibizumab for visual acuity in neovascular AMD, supporting its widespread off-label use.