Vascular endothelial growth factor (VEGF) is a protein produced in the eye in response to reduced oxygen supply to tissues. This protein forms new blood vessels, which grow rapidly and are irregular in their shape and function resulting in bleeding and swelling that reduce vision and further lead to anatomical damage to the eye.

The following injections are used as anti-VEGF treatment:

• Bevacizumab is an off label preparation used to treat retinal diseases.
• Aflibercept is a drug registered for the treatment of macular edema in diabetic retinopathy (swelling of the clear vision point as a complication in people with diabetes), retinal vein occlusion and myopic macular degeneration with consequent neovascularization in the center of clear vision, wet form of senile macular degeneration.
• Faricimab is a humanized bispecific immunoglobulin G1 (IgG1) antibody that works by neutralizing both angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A), thereby inhibiting two distinct signaling pathways. With its dual inhibition of Ang-2 and VEGF-A, the drug faricimab reduces vascular permeability and inflammation, inhibits pathological angiogenesis and restores vascular stability.
• Brolucizimab is a drug that binds to the signaling protein vascular endothelial growth factor A and thus blocks it, and is intended for patients with senile macular degeneration. By blocking VEGF-A, brolucizumab reduces abnormal blood vessel growth, protects the macula from damage, and controls the progression of wet senile macular degeneration.

Anti-VEGF treatment blocks VEGF proteins and thus prevents the formation of abnormal (unnatural) blood vessels in the eye. It reduces or completely prevents the damage caused by those blood vessels, both to the eye and to the eyesight.

Candidates for anti-VEGF treatment are all persons with diagnoses:

• Macular edema in diabetic retinopathy (swelling of the clear vision point as a complication in people with diabetes);
• Retinal vein occlusion (clogging of retinal blood vessels by a thrombus);
• Myopic central neovascularization;
• Wet form of senile macular degeneration (wet macular degeneration).

These diseases are also the leading causes of blindness in people older than 50 years. Prior to these injections, these conditions usually resulted in vision loss in one or both eyes.

A subspecialty examination is performed, which consists of refraction, determination of visual acuity, measurement of eye pressure, examination of the fundus – examination of the anterior and posterior segment of the eyes.

If necessary, OCT – optical coherence tomography is performed as well as additional diagnostic examinations at the request of the ophthalmologist.

After the examination, the patient receives the report and the results of the diagnostic tests.

The application of intravitreal injections is a simple short procedure, which is performed under local anesthesia and does not require special preparation before treatment.

The treatment takes place in the operating room.

Anesthetic drops are inserted into the patient’s eye and a lid holder is placed to keep the eye open.

The ophthalmologist then injects the drug into the white part of the eye (sclera) using a very thin needle. The application itself lasts only a few seconds so that the patient does not notice the needle and does not feel pain.

After the drug is applied, the patient stays in our clinic for a short time and the eye pressure is measured again. The patient goes home the same day.

This drug works for a certain period of time (from 1 to 3 months) and the application must be repeated at certain intervals until complete stabilization of the disease.

Expected reactions after application (injection) of the drug are:

• Slight discomfort and redness on the day of treatment;
• Opacities (dark spots) in the lower part of the visual field, a few days after application.

There are no restrictions on normal work and life responsibilities after application of the drug.

No need for accompaniment on the day of application of the drug.

In case the patient feels very strong pain in the eye, if the redness worsens, if it is hypersensitive to light, there is swelling or the vision deteriorates sharply, it is necessary to immediately ask an ophthalmologist or our clinic – each patient has a phone number from their doctor.

For the anti-VEGF treatment we do not have cooperation with the Health Insurance Fund of RNM.

For more information contact us by phone 02 3097 000 or electronically at contact@sistinaoftalmologija.mk.

The package includes: pre-applicative preparation; anesthetic drops.

There is an opportunity to pay in installments without interest and additional costs.

You can learn more about the payment method on the current price list of Sistina Ophthalmology.