16
Treatment
Anti-VEGF Therapy
Î Anti-VEGF therapy is the treatment of choice for macular edema with or
without focal laser treatment. (I++, G, S)
Î Treating physicians should note that the use of betadine antiseptic
drops is recommended during intravitreal injections. (III, G, S)
Î Individuals receiving the intravitreal injections of anti-VEGF agents may
be examined 1 month following therapy. (III, G, S)
Î The use of routine antibiotic eye drops is NOT recommended before or
following intravitreal injection procedures. (III, In, D)
Î Preoperatively, the ophthalmologist should discuss with the patient the
side effects and risks of treatment. (III, G, S)
Î When treatment for macular edema is deferred, the patient should be
observed closely (at least every 3–4 months) for signs of progression.
(III, G, S)
Table 7. Intravitreal Agents
Drug Dose
Anti-VEGF Agents
Aflibercept
2 mg intravitreal monthly × 5 months, then 2 mg every 2 months
a
Ranibizumab
0.5 mg intravitreal monthly
b
Intravitreal corticosteroids
Dexamethasone
intravitreal
implant
0.7 mg in the solid polymer drug delivery system
c
Fluocinolone
acetonide
intravitreal
implant
0.19 mg fluocinolone acetonide in a drug delivery system
d
a
Aflibercept — Eylea
®
[package insert]. Tarrytown, NY: Regeneron Pharmaceuticals, Inc. 2014.
b
Ranibizumab — Lucentis
®
[package insert]. South San Francisco, CA: Genentech, Inc. 2015.
c
Dexamethasone intravitreal implant — Ozurdex
®
[package insert]. Irvine, CA: Allergan, Inc.
2014.
d
Fluocinolone acetonide intravitreal implant — Iluvien
®
[package insert]. Alpharetta, GA: Alimera
Sciences, Inc. 2014.
