Changing indications for intravitreal anti-vascular endothelial growth factor injections at the university college hospital, Ibadan, Sub-Saharan Africa

Adeyemi Timothy Adewole, Tunji Sunday Oluleye, Yewande Olubunmi Babalola, Oluwole Majekodunmi, Modupe Ijaduola


Background: To review the current indications for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, in order to make recommendations for planning of services.

Methods: The medical records of 172 patients who had intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections from January 2016 to December 2019 were retrieved. Socio-demographic and clinical data were extracted, analysed, and compared with data from the previously published audit report covering 2010 to 2012.

Results: Three hundred and thirty injections were given to 182 eyes in this cohort of patients. The mean age was 61.1±16.3 years (range <1-90 years), with a male to female ratio of 1.1:1. Retinal vein occlusion, 64 (35%) remained the most common indication for anti-VEGF injections in the eyes treated. This was followed by choroidal neovascular membrane/wet age-related macular degeneration which accounted for 42 (23%) as reported previously. However, cases of proliferative diabetic retinopathy/ diabetic maculopathy needing anti-VEGF were noticed to have almost doubled from about 8 (10%) in the previous study to 15 (27%) in the present study. In addition, idiopathic polypoidal choroidal vasculopathy, 18 (10%) ranked above proliferative sickle cell retinopathy in the present study. Retinopathy of prematurity (ROP), neovascular glaucoma, retinal artery macro-aneurysm and myopic choroidal neovascular membrane were the new emerging indications.

Conclusion: There is an expanding indication for anti-VEGF in the management of retinal vascular diseases in the health facility and adequate measures should be put in place for early diagnosis and management. Patients should be counselled on the availability of this treatment option.


Retinal diseases, Intravitreal injections, Anti-VEGF, Indications

Full Text:



Pham B, Thomas SM, Lillie E, Lee T, Hamid J, Richter T et al. Anti-vascular endothelial growth factor treatment for retinal conditions: A systematic review and meta-analysis. BMJ Open. 2019;9(5):022031.

Calvo-Gonzalez C, Reche-Frutos J, Donate J, Fernandez-Perez C, Garcia-Feijoo J. Intravitreal ranibizumab for myopic choroidal neovascularization: Factors predictive of visual outcome and need for retreatment. Am J Ophthalmol. 2011;151(3):529-34.

Chin-Yee D, Eck T, Fowler S, Hardi A, Apte RS. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration. British J Ophthalmol. 2016;100:914-7.

Haller JA. Current anti-vascular endothelial growth factor dosing regimens: Benefits and burden. Ophthalmol. 2013;120(5):S3.

Oluleye TS, Ajaiyeoba AI. Retinal diseases in Ibadan Eye. Nature Publishing Group. 2006;20(12):1461-3.

Oluleye TS, Babalola Y. Indications for Intravitreal Bevacizumab in Ibadan, Sub-Saharan Africa. Open Ophthalmol J. 2014;8(1):87-90.

Fiebai B, Odogu V. Intravitreal Anti Vascular Endothelial Growth Factor Agents in The Management of Retinal Diseases: An Audit. Open Ophthalmol J. 2017;11(1):315-21.

Bogunjoko TJ, Hassan A, Oderinlo O, Ogugua O, Ulaikere M, Akanbi T et al. A Review of the Use of Anti-vascular Endothelial Growth Factor Drugs at the Eye Foundation Centre for the Prevention of Blindness, Nigeria. J Adv Med Med Res. 2018;27(1):1-7.

Adenekan AO, Rotimi-Samuel A, Oluleye TS, Ilo OT, Musa KO, Amusan OO. Indications for intravitreal injections in Lagos University Teaching Hospital, Lagos, Nigeria. Nig Q J Hosp Med. 2017;27(2):765-7.

Hassan S, Shuaib A. Indications for intravitreal anti vascular endothelial growth factor in Kano, North Western, Nigeria. Int J Res Med Sci. 2016;4(7):2533-5.

Uhumwangho O. Indications and treatment outcomes of intravitreal bevacizumab and ranibizumab for retinal diseases in Benin City, Nigeria. Niger J Ophthalmol. 2017;25(1):14.

Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli M V et al. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Heal. 2017;5(12):1221-34.

Leasher JL, Bourne RRA, Flaxman SR, Jonas JB, Keeffe J, Naidoo K et al. Global Estimates on the Number of People Blind or Visually Impaired by Diabetic Retinopathy: A Meta-analysis From 1990 to 2010. Diabetes Care. 2016;39(9):1643-9.

Khanna S, Komati R, Eichenbaum DA, Hariprasad I, Ciulla TA, Hariprasad SM. Current and upcoming anti-VEGF therapies and dosing strategies for the treatment of neovascular AMD: A comparative review. BMJ Open Ophthalmol. 2019;4:000398.

Low A, Faridi A, Bhavsar KV, Cockerham GC, Freeman M, Fu R et al. Comparative effectiveness and harms of intravitreal antivascular endothelial growth factor agents for three retinal conditions: A systematic review and meta-analysis. Bri J Ophthalmol. 2019;103:442-51.

Gurav R, S Kartikeyan. Problems of Geriatric Population in Urban Area. Bombay Hospital J. 2002;44:47-51.

Oluleye TS, Babalola Y. Pattern of presentation of idiopathic polypoidal choroidal vasculopathy in Ibadan, Sub-Saharan Africa. Clin Ophthalmol. 2013;7:1373-6.

Razzaq AA, Al-Mafrachi M, Hussein ZR, Yasir B, Abdul S, Kaptan M et al. Ranibizumab Intravitreal Injection-Monotherapy-Treatment for Retinopathy of Prematurity in Iraq. J Clin Exp Opthamol. 2018;9(4).

Mintz-Hittner HA, Kennedy KA, Chuang AZ. Efficacy of Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity. Engl J med. 2011;364:603-615

Genie M, Bang SJB. Bevacizumab for the Treatment of Retinopathy of Prematurity. Medscape. Viewpoints in Retina. 2012.

Sankar MJ, Sankar J, Chandra P. Anti-vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity. Cochrane database Syst Rev. 2018;1(1):CD009734.

Baumal CR, Goldberg RA, Fein JG. Primary intravitreal ranibizumab for high-risk retinopathy of prematurity. Ophthalmic Surg Lasers Imaging Retin. 2015;46(4):432-8.

Mameesh M, Ganesh A, Al Zuhaibi S. Facing the epidemic of myopia: Exploring the possibilities. Vol. 10, Oman Journal of Ophthalmology. Medknow Publications. 2017;10(2):61-2.

Flanagan J, Fricke T, Morjaria P, Yasmin S. Myopia: A growing epidemic. Community Eye Heal J. 2019;32(105):99.

Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmol. 2016;123(5):1036-42.

World Health Organization. Informe mundial sobre la visión. WHO, 2019. Available at Accessed on 10/7/2020.