Age related macular degeneration by ranibizumab injection

1. Advances Treatment in the Age-
Related Macular Degeneration (AMD)
by Ranibizumab Injection
Presented by
Sugata Som
3RD Year B.Pharm Sec- B
Roll: 19301913088
Bengal School of Technology

2. What is Age-Related Macula Degeneration?
Age related macula degeneration (AMD) is defined as the
loss of macular function from the degenerative changes of
aging.
The macula is the most important part of the retina that
responsible for sharp, central vision.
AMD is divided specifically two distinct types:
A) DRY (less severe)
B) WET (more severe)
Basically Ranibizumab injection work on WET type AMD.
The root causes of this AMD are still unknown.

3. Difference between normal retina and
affected retina

4. What are the risk factors for AMD?

5. How is AMD Diagnosed?
As the many other medical conditions , the approach to
diagnosing AMD requires the integration of both the patient
history and the physical exam.
Commonly test Lipid Profile, Sugar fasting & PP and check
the Oxygen level in the body and monitoring the BP.
Fundus fluorescein angiography examination detect the dry
AMD only display changes in retinal pigment epithelium
along with DRUSEN (yellow deposits).
Scan of both eye is need for detect the Wet AMD display the
GREEN & RED spot in retina.

6. Scan report of affected & normal eye.

7. Wet Macular Degeneration???????
Abnormal blood vessels grow up from the choroid behind
the retina.
Aggressive and faster Progression of vascular endothelial.
Blindness, Low vision found.
VASCULAR ENDOTHELIAL GROWTH FACTOR
(VEFG) is mainly responsible for WET AMD.
Photoreceptors (Rods and Cones) are damaged.
New capillaries break through Bruch’s membrane into the
base of RPE.

9. What is the VEGF ????
Vascular Endothelial Growth Factor (VEGF),originally
known as vascular permeability factor (VPF), is a signal
protein produced by cells that stimulates vasculogenesis
and angiogenesis. It is part of the system that restores the
oxygen supply to tissues when blood circulation is
inadequate.

10. Why VEGF is responsible in Wet-AMD??
VEGF’s normal function is create new blood vessels during
embryonic development, new blood vessels after injury,
muscle following exercise, and new vessels to bypass
blocked vessels.
When VEGF is over expressed, it can contribute to disease.
Over expression of VEGF can cause vascular disease in the
retina of the eye.
Drugs such a Avastin, Bevacizumab,
RANIBIZUMAB can inhabit VEGF and control or slow
Wet AMD.

12. Why Ranibizumab Injection ???
Ranibizumab (trade name Lucentis among others) is a
MONOCLONALANTIBODY FRAGMENT (FAB) .
It is an anti-angiogenic that has been approved to treat the
WET type age-related macular degeneration (AMD),
a common form of Vision loss.
Its rates of side effect shorter than Bevacizumab.
Ranibizumab was developed by Genetech and is marketed
by Genetech and Novartis, under brand name Lucentis.

13. Dosage & administration of Ranibuzimab??
The recommended dose of Lucentis is 0.5 mg (0.05 ml)
or 0.3 mg (0.03 ml) given as a single intravitreal
injection.

14. How Ranibizumab work (MODE of ACTION)
Ranibizumab binds to receptor binding site active forms
of VEGF-A.
The binding of ranibizumab to VEGF-A prevents the
interaction of VEGF-A with receptor on the endothelial
cells, reducing endothelial cell proliferation, vascular
leakage and new blood vessel formation.

16. Adverse effect of Ranibizumab Injection
Ranibizumab Injection is a monoclonal antibody that works by
slowing the growth of abnormal new blood vessels in the eye
and decreasing leakage from of wet AMD.
1. Increased tears in affected eye (s).
2. Itchy or watery eyes
3. Dry eyes
4. Swelling of eyelids
5. Blurred vision
6. Eye redness
7. Joint pain
8. vomiting
9. Nausea
10. Eye pain
This injection administered as an injection into the eye, with
local aesthetic.

17. Any Precautions Should follow before administration?????
1.To infrom doctor or Pharmacist if allergic to
ranibizumab, any other medications, or any of the
ingredients in ranibizumab injection
2. To infrom doctor and pharmacist what other
prescription and non prescription medicine, vitamins,
herbal products.
3. Tell doctor if patient is pregnant, plan to become
pregnant, or are breast feeding. If become pregnant while
receiving ranibizumab.
4. Any infection is found in eye inform doctor.

18. Barrier of AMD treatment
The Ranibuzimab injection is very much costly. The cost of
per injection is RS.25000 in India (Price source from Disha
Eye Hospital in WB).
So, its treatment is not affordable to person. Those have
Medical Insurance they are take chance easy.
This is treatment is 1 year long term procedure.
Any other same category drug???
Ranibizumab like some drugs found in market.
Bevacizumab (Avastin), Pegaptanib Sodium is works as an
anti VEGF drug.

19. References:
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A; Feinberg, E B (2010). "Bevacizumab vs ranibizumab for age-related macular
degeneration: 1-year outcomes of a prospective, double-masked randomised clinical
trial". Eye 24 (11): 1708–1715.
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D'Amico, R; Dickersin, K; Kodjikian, L; Lindsley, K; Loke, Y; Maguire, M; Martin, DF;
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3.Solomon, SD; Lindsley, K; Vedula, SS; Krzystolik, MG; Hawkins, BS (Aug 29, 2014).
"Anti-vascular endothelial growth factor for neovascular age-related macular
degeneration.". The Cochrane database of systematic reviews 8: CD005139.
4. Lucentis Prescribing Information. Genentech. June 2010.
5. Chakravarthy U; Harding SP; Rogers CA; Downes SM; Lotery AJ; Culliford LA;
Reeves BC; IVAN study investigators (Oct 12, 2013). "Alternative treatments to inhibit
VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN
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YK (2012). "A safety review and meta-analyses of bevacizumab and ranibizumab.

20. Than