Ranibizumab

How it works

It binds and neutralises VEGF-A, inhibiting the abnormal angiogenesis and vascular leakage that drive macular oedema and choroidal/retinal neovascularisation.

Prescribing in practice

• Intravitreal injection carries a risk of endophthalmitis, intraocular inflammation, retinal detachment and raised intraocular pressure, so it must be administered under aseptic conditions by a trained ophthalmologist with monitoring for signs of infection.
• There is a theoretical risk of arterial thromboembolic events associated with systemic VEGF inhibition.
• Treatment requires assessment of intraocular pressure and ocular perfusion around the time of injection.

Monitoring

Patients require monitoring of intraocular pressure and for signs of endophthalmitis or intraocular inflammation after each injection, with regular review of visual acuity and retinal imaging.

Counselling the patient

• Report any eye pain, increasing redness, sensitivity to light or vision changes after injection immediately, as these can signal infection.
• Attend all scheduled review and injection appointments, as treatment is ongoing.
• Mild eye discomfort or floaters can occur shortly after the injection.

Evidence & guidelines

Ranibizumab is recommended by NICE for wet AMD and other retinal indications, supported by landmark trials such as MARINA and ANCHOR in neovascular AMD.