Intravitreal treatment for wet AMD and Diabetic Macular Oedema

Intravitreal Vabysmo (Faricimab) as the most effective management for vascular leakage

In patients suffering from DMO and wet AMD, reducing the fluid in their macula, is the mainstay of treatment. Anti-VEGF intravitreal injections have been an effective treatment, used since 2007 in most countries. Vabysmo is the latest generation intravitreal injection and first licensed treatment to combine anti-VEGF and anti-Ang-2 action, providing quicker resolution of fluid and larger interims between follow-ups in most cases. Intravitreal treatments with earliest generation anti-VEGF have been successfully preventing vision loss in most cases. However, in some cases patients are unresponsive to the treatments or have to receive injections very frequently, sometimes indefinitely. Data from RHINE and YOSEMITE clinical trials pooled showed approximately 60% of the patients receiving Vabysmo achieved 16-weekly follow-ups and more than 80% of the patients achieved 12-weekly or more follow-ups.

Important pre-intravitreal treatment considerations

Some patients may have had a recent stroke or heart attack. It is important that this is addressed with their physician first and intravitreal treatment does not start until 3 months after any new onset of stroke or heart attack. Patients with very high blood pressure or uncontrolled angina are also advised to address these prior to receiving intravitreal injections. It is also crucial for any eye infection or severe blepharitis to be treated in advance of intravitreal injections to reduce the risk of endophthalmitis. Vabysmo belongs to a category of drugs called anti-VEGF, which are better avoided during pregnancy.

Reducing risk of complications

Some patients may have high intraocular pressures following their injections. A Medical Retina specialist will check the patient’s eye pressure before and after delivering the intravitreal treatment and provide further intraocular pressure lowering agents if necessary.

Intravitreal injection aftercare

After the treatment, patients are given lubricating drops to take home with the instruction to put them in four times a day for five days. In some cases, patients might need to wait to have their eye pressure checked right after the injection. The next appointment is scheduled the same day. Most new patients require a loading course of four or five injections at regular intervals of four weeks. After the first course of injections, the majority of patients will require further injections at extended intervals, depending on the leakiness of their blood vessels.

Switching from a different intravitreal treatment

Some patients may have been receiving intravitreal application of a different drug. If they are responding well to their current treatment, most times it is recommended that they continue with the drug they have already been receiving. The need to switch to Vabysmo will be evaluated by a medical retina consultant depending on the anatomical appearance and presence of fluid on the scans, the follow-up intervals achieved so far as well as the current visual acuity. Patients with established extensive foveal-involving chorio-retinal atrophy have no benefit to commence on Vabysmo.