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Anti-VEGF (intravitreal injection) Pregnancy: Avoid — anti-VEGF may affect fetal development. Use only if sight-threatening and no alternatives.

Ranibizumab

Brand names: Lucentis

Adult dose

Dose: 0.5 mg (0.05 mL) intravitreal injection monthly for 3 months, then as needed or every 2 months
Route: Intravitreal injection (by trained ophthalmologist, in sterile theatre/clean room)
Frequency: Monthly loading (3 doses), then PRN or 2-monthly (T&E or T&T protocol)
Max: 0.5 mg per injection
Wet AMD, diabetic macular oedema (DMO), RVO with macular oedema: 0.5 mg monthly loading × 3, then monitor and re-treat (PRN) or treat and extend (T&E). Applied under topical anaesthesia via intravitreal route. Bevacizumab (off-label) and aflibercept are alternatives.

Paediatric dose

Route: Intravitreal
Frequency: Not applicable
Max: Not licensed in children
Not licensed for use in children.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

  • Endophthalmitis: patient must present within 24 hours if eye becomes very red, painful, or vision deteriorates after injection
  • Bevacizumab (Avastin) used off-label — similar efficacy, much lower cost (IVAN/CATT trials)
  • Aflibercept (Eylea) requires fewer injections in Year 2 — preferred by some centres
  • Treat and extend (T&E) reduces injection burden
  • NICE TA294: ranibizumab for wet AMD if VA 6/12–6/96 and lesion meets criteria

Contraindications

  • Active ocular or periocular infection
  • Active intraocular inflammation
  • Hypersensitivity to ranibizumab

Side effects

  • Endophthalmitis (risk: ~0.05% per injection — sight-threatening emergency)
  • Retinal tear or detachment
  • Intraocular inflammation (anterior or posterior uveitis)
  • Raised IOP (transient post-injection)
  • Vitreous haemorrhage
  • Systemic events (stroke, MI) — rare but theoretical

Interactions

  • No systemic drug interactions (intravitreal route)

Monitoring

  • VA testing before each injection
  • OCT imaging (fluid on macula)
  • IOP post-injection
  • Endophthalmitis symptoms

Reference: BNFc; BNF; NICE TA294; NICE TA274; IVAN trial; CATT trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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