Lucentis (Ranibizumab)
Anti-VEGF Eye Injection for Retinal Diseases
Quick Facts About Lucentis
Key Takeaways
- Lucentis is an anti-VEGF medication injected directly into the eye to treat retinal diseases including wet AMD, diabetic macular edema, and retinal vein occlusion.
- Treatment typically begins with monthly injections for three months, then continues with individualised dosing intervals based on disease activity.
- In clinical trials, approximately 30–40% of wet AMD patients gained significant vision improvement, and the majority maintained or improved their vision.
- The most common side effects are eye-related and include conjunctival haemorrhage, eye pain, vitreous floaters and increased intraocular pressure.
- Several approved biosimilars (Byooviz, Ranivisio, Ximluci, Rimmyrah) offer equivalent efficacy at potentially lower cost.
What Is Lucentis and What Is It Used For?
Quick answer: Lucentis (ranibizumab) is an anti-VEGF medicine given as an injection into the eye. It treats several conditions that cause vision loss due to abnormal blood vessel growth or fluid leakage in the retina, including wet age-related macular degeneration and diabetic eye disease.
Lucentis belongs to a class of medications called anti-neovascular agents or anti-VEGF drugs. The active ingredient, ranibizumab, is a humanised monoclonal antibody fragment (Fab) that was specifically designed to target and neutralise vascular endothelial growth factor A (VEGF-A). VEGF-A is a signalling protein that plays a central role in both normal and abnormal blood vessel formation. When present in excess in the eye, VEGF-A promotes the growth of fragile new blood vessels that are prone to leaking fluid and blood into the retina, leading to progressive vision loss.
By binding to VEGF-A with high affinity, ranibizumab prevents it from activating its receptors (VEGFR-1 and VEGFR-2) on the surface of endothelial cells. This blocks the cascade of signals that would otherwise drive new blood vessel formation (neovascularisation) and reduces the increased vascular permeability that causes fluid accumulation (edema) in the retina. The net result is a reduction in retinal swelling and stabilisation or improvement of visual acuity.
Lucentis was first approved by the United States Food and Drug Administration (FDA) in 2006 and by the European Medicines Agency (EMA) in 2007. It was developed by Genentech (a member of the Roche Group) and is marketed globally by Novartis. The drug represented a breakthrough in ophthalmology, being one of the first anti-VEGF agents specifically developed for intravitreal use.
Approved Indications
Lucentis is approved for the treatment of several retinal conditions in adults and, in certain formulations, premature infants:
- Wet (neovascular) age-related macular degeneration (wet AMD) – The most common indication, where abnormal blood vessels grow beneath the macula, causing central vision loss.
- Diabetic macular edema (DME) – Swelling of the macula caused by leaking blood vessels in patients with diabetes, a leading cause of vision impairment in working-age adults.
- Macular edema following retinal vein occlusion (RVO) – Both branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) can cause macular swelling and vision loss.
- Choroidal neovascularisation (CNV) secondary to pathologic myopia – Abnormal blood vessel growth under the retina in patients with severe short-sightedness.
- Retinopathy of prematurity (ROP) – A condition in premature infants where abnormal blood vessels develop in the retina, potentially leading to blindness if untreated.
What Should You Know Before Receiving Lucentis?
Quick answer: Lucentis must not be used if you have an active eye infection, severe intraocular inflammation, or are allergic to ranibizumab. Your ophthalmologist will perform a thorough eye examination before each injection and monitor you closely afterwards.
Contraindications
Lucentis should not be administered in the following circumstances:
- Known hypersensitivity to ranibizumab or any of the excipients (trehalose dihydrate, histidine hydrochloride, histidine, polysorbate 20, water for injections).
- Active or suspected ocular or periocular infection – Any infection in or around the eye must be fully treated before Lucentis can be given, as the injection procedure could worsen the infection.
- Active severe intraocular inflammation (uveitis) – Significant inflammation inside the eye increases the risk of complications from the injection.
Warnings and Precautions
Intravitreal injections, including those with Lucentis, are associated with certain procedural risks that require careful management. The most important warnings include:
- Endophthalmitis – A serious but rare infection of the interior of the eye that can occur following any intravitreal injection. Strict aseptic technique is essential to minimise this risk. Patients should report any signs of eye pain, redness, light sensitivity, or worsening vision immediately.
- Increased intraocular pressure (IOP) – Transient increases in eye pressure have been observed within 60 minutes of the injection. Sustained IOP elevations have also been reported with repeated injections. IOP should be monitored after each treatment.
- Retinal detachment and retinal tears – Detachment or tears of the retinal layers, including the retinal pigment epithelium, have been reported. Patients should be instructed to report any sudden onset of floaters, flashes of light, or vision loss.
- Traumatic cataract – The injection needle can potentially damage the lens of the eye, leading to cataract formation.
- Arterial thromboembolic events – Although intravitreal anti-VEGF therapy results in minimal systemic VEGF inhibition, a theoretical risk of cardiovascular events (stroke, myocardial infarction) exists. This risk should be considered in patients with known cardiovascular risk factors.
Pregnancy and Breastfeeding
There are no adequate data on the use of ranibizumab in pregnant women. Animal studies have shown embryo-foetal toxicity at high systemic exposures. Although systemic exposure after intravitreal injection is very low, Lucentis should not be used during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. Women of childbearing potential should use effective contraception during treatment and for at least three months after the last injection.
It is not known whether ranibizumab is excreted in human breast milk. As a precaution, breastfeeding is not recommended during treatment with Lucentis. Discuss the benefits and risks with your healthcare provider to make an informed decision.
How Does Lucentis Interact with Other Drugs?
Quick answer: Formal drug interaction studies have not been conducted with Lucentis. Because systemic exposure after intravitreal injection is very low, clinically significant interactions with systemic medications are unlikely. However, concurrent use of other anti-VEGF agents is not recommended.
The intravitreal route of administration results in minimal systemic absorption of ranibizumab. Maximum serum concentrations following intravitreal injection are approximately 1,000-fold lower than concentrations needed to inhibit VEGF activity systemically. As such, pharmacokinetic drug interactions with systemically administered medications are not expected to be clinically relevant.
However, there are important considerations regarding the concurrent use of other ophthalmic treatments:
| Drug / Class | Type | Details |
|---|---|---|
| Bevacizumab (Avastin) | Major | Concurrent intravitreal use is not recommended. Both agents target VEGF-A and combining them does not provide additive benefit but may increase adverse effects. |
| Aflibercept (Eylea) | Major | Should not be administered concurrently. Switching between anti-VEGF agents should be done with appropriate washout periods as guided by the treating ophthalmologist. |
| Brolucizumab (Beovu) | Major | Concurrent use is not recommended. Cross-switching should be managed by a retinal specialist. |
| Verteporfin (PDT) | Moderate | Photodynamic therapy with verteporfin has been used in combination with ranibizumab in some treatment protocols for wet AMD. If used together, the timing and sequence should be carefully planned. |
| Topical corticosteroids | Minor | Topical anti-inflammatory eye drops are often prescribed after intravitreal injections to reduce post-procedural inflammation. This is standard practice and not a harmful interaction. |
| Anticoagulants / Antiplatelets | Minor | Patients taking blood thinners (warfarin, aspirin, clopidogrel) may have a slightly higher risk of subconjunctival haemorrhage at the injection site. This is generally harmless and self-resolving. |
Always inform your ophthalmologist about all medications you are taking, including prescription drugs, over-the-counter medicines, eye drops, and herbal supplements. Although systemic interactions are unlikely, your complete medication history helps your doctor provide the safest possible care.
What Is the Correct Dosage of Lucentis?
Quick answer: The standard adult dose is 0.5 mg (0.05 ml) injected into the vitreous of the eye. Treatment begins with monthly injections and is then individualised. For premature infants with ROP, the dose is 0.2 mg (0.02 ml) per eye.
Lucentis must only be administered by a qualified ophthalmologist experienced in intravitreal injections. The injection is performed under aseptic conditions with appropriate anaesthesia and a broad-spectrum topical antimicrobial applied to the eye before the procedure. Each vial or pre-filled syringe is intended for single use only.
Adults – Wet Age-Related Macular Degeneration
Wet AMD Dosing
Dose: 0.5 mg (0.05 ml of 10 mg/ml solution) by intravitreal injection.
Loading phase: One injection per month for three consecutive months.
Maintenance: After the loading phase, monitoring and treatment intervals are individualised based on disease activity. Using a treat-and-extend protocol, intervals between injections are gradually extended by 2-week increments (up to every 12 weeks) as long as the disease remains stable. If disease activity recurs, the interval is shortened.
Minimum interval: At least 4 weeks between injections.
Adults – Diabetic Macular Edema
DME Dosing
Dose: 0.5 mg (0.05 ml) by intravitreal injection.
Treatment: Monthly injections continued until maximum visual acuity is achieved and/or there are no signs of disease activity (stable visual acuity for three consecutive monthly assessments). Treatment is resumed if monitoring indicates loss of visual acuity due to DME.
Monitoring: Monthly assessments are recommended. Treatment may also follow a treat-and-extend approach.
Adults – Retinal Vein Occlusion
RVO Dosing (BRVO and CRVO)
Dose: 0.5 mg (0.05 ml) by intravitreal injection monthly.
Treatment: Monthly injections until maximum visual acuity is achieved and/or there are no signs of disease activity. A minimum of three injections may be needed.
Monitoring: If no improvement after three injections, continued treatment is not recommended. Monthly monitoring should continue, and treatment is restarted if disease activity returns.
Premature Infants – Retinopathy of Prematurity
ROP Dosing
Dose: 0.2 mg (0.02 ml of 10 mg/ml solution) by intravitreal injection.
Treatment: Treatment begins with one injection per eye (may be given bilaterally on the same day). Up to three injections per eye may be given within six months of initiating treatment if there are signs of disease activity.
Minimum interval: At least 4 weeks between doses in the same eye.
Clinical data: In the RAINBOW clinical trial, most patients (78%) required only a single injection per eye. Patients treated with 0.2 mg did not need additional treatment in the long-term follow-up study through five years of age.
Missed Dose
If you miss a scheduled Lucentis injection, contact your ophthalmologist as soon as possible to reschedule. Do not attempt to compensate by receiving a double dose. Regular monitoring and timely treatment are essential for maintaining the therapeutic benefit. Delays in treatment may allow disease progression and vision loss.
Overdose
Overdose from intravitreal injection is unlikely given the controlled clinical setting in which Lucentis is administered. Cases of accidental overdose with injection volumes higher than recommended have been reported. In these cases, increased intraocular pressure, transient blindness, pain and reduced visual acuity were observed. If an inadvertent overdose occurs, intraocular pressure should be monitored and treated if clinically indicated. The ophthalmologist should observe the patient and initiate appropriate management.
| Indication | Dose | Loading Phase | Maintenance |
|---|---|---|---|
| Wet AMD | 0.5 mg (0.05 ml) | Monthly × 3 months | Treat-and-extend (q4–12 weeks) |
| DME | 0.5 mg (0.05 ml) | Monthly until stable | PRN or treat-and-extend |
| BRVO / CRVO | 0.5 mg (0.05 ml) | Monthly (min. 3 months) | PRN based on disease activity |
| Myopic CNV | 0.5 mg (0.05 ml) | Single injection | PRN (monthly monitoring) |
| ROP (infants) | 0.2 mg (0.02 ml) | 1 injection per eye | Up to 3 per eye in 6 months |
What Are the Side Effects of Lucentis?
Quick answer: Like all medicines, Lucentis can cause side effects, though not everyone experiences them. The most common are eye-related effects from the injection procedure, including conjunctival haemorrhage, eye pain, vitreous floaters and increased intraocular pressure. Serious but rare complications include endophthalmitis and retinal detachment.
The side effects associated with Lucentis treatment fall into two categories: those related to the drug itself and those related to the intravitreal injection procedure. Most side effects are ocular (affecting the eye) and are generally mild and transient. The frequencies below are based on pooled data from clinical trials and post-marketing surveillance.
Side Effects by Frequency
Very Common
Affects more than 1 in 10 patients
- Conjunctival haemorrhage (bloodshot eye at injection site)
- Eye pain
- Vitreous floaters (small particles or spots in the field of vision)
- Intraocular inflammation (vitritis, uveitis)
- Visual disturbances
- Increased intraocular pressure
- Vitreous detachment
- Retinal haemorrhage
- Eye irritation
- Foreign body sensation in the eye
- Increased tear production
- Blepharitis (inflammation of the eyelid margins)
- Dry eye
- Eye redness or itching
- Headache
- Joint pain (arthralgia)
Common
Affects 1 in 10 to 1 in 100 patients
- Decreased visual acuity
- Corneal and uveal inflammation
- Corneal erosion or abrasion
- Blurred vision
- Conjunctivitis (discharge with itching, redness and swelling)
- Light sensitivity (photophobia)
- Eye discomfort
- Eyelid swelling or pain
- Anxiety, nausea
- Nasopharyngitis (sore throat, nasal congestion)
Uncommon
Affects 1 in 100 to 1 in 1,000 patients
- Endophthalmitis (serious eye infection) with intraocular inflammation
- Blindness
- Retinal detachment or tear
- Retinal pigment epithelium detachment or tear
- Cataract (lens clouding), traumatic cataract
- Inflammation and haemorrhage in the anterior chamber
- Hypopyon (pus accumulation in the eye)
- Injection site pain, irritation or abnormal sensation
- Eyelid irritation
Rare
Affects fewer than 1 in 1,000 patients
- Hypersensitivity reactions including anaphylaxis/anaphylactoid reactions
- Corneal transplant rejection (in patients with prior corneal grafts)
- Arterial thromboembolic events (stroke, transient ischaemic attack)
Side Effects in Premature Infants (ROP)
In premature infants treated for retinopathy of prematurity, the side effect profile includes both ocular and systemic effects. Eye-related effects include retinal haemorrhage, conjunctival haemorrhage and haemorrhage at the injection site. Systemic effects reported include sore throat, nasal congestion, runny nose, anaemia (low red blood cell count, with symptoms such as fatigue, breathlessness and pallor), cough, urinary tract infection, and allergic reactions such as rash and skin redness.
How Should You Store Lucentis?
Quick answer: Lucentis must be stored in a refrigerator at 2°C to 8°C, protected from light. It must not be frozen. Before use, an unopened vial may be kept at room temperature (up to 25°C) for up to 24 hours.
Proper storage of Lucentis is essential to maintain its stability and efficacy. In clinical practice, Lucentis is stored and handled by pharmacy and healthcare professionals, but understanding storage requirements can be helpful for patients who want to be informed about the quality of their treatment.
- Storage temperature: 2°C to 8°C (refrigerate). Do not freeze under any circumstances, as freezing can damage the protein structure of ranibizumab and render the medication ineffective.
- Light protection: Keep the vial in its original carton to protect from light. Exposure to light can degrade the active substance.
- Room temperature use: Prior to use, the unopened vial may be stored at room temperature (up to 25°C) for up to 24 hours. After this period, if not used, the vial should be discarded.
- Expiry date: Do not use after the expiry date printed on the carton and vial label (marked as EXP). The expiry date refers to the last day of the stated month.
- Damaged packaging: Do not use the product if the packaging appears damaged or tampered with, as sterility cannot be guaranteed.
- Single use only: Each vial is for single use only. Any unused solution must be disposed of in accordance with local requirements for biological waste.
What Does Lucentis Contain?
Quick answer: Each millilitre of Lucentis solution contains 10 mg of the active substance ranibizumab. Each vial contains 2.3 mg of ranibizumab in 0.23 ml of solution, providing an appropriate amount for the required dose.
Active Substance
The active ingredient is ranibizumab, a humanised monoclonal antibody fragment produced in Escherichia coli by recombinant DNA technology. Each millilitre contains 10 mg of ranibizumab. Ranibizumab has a molecular weight of approximately 48 kDa and is designed to specifically bind human VEGF-A with high affinity (Kd ≈ 0.5 nM).
Inactive Ingredients (Excipients)
- α,α-trehalose dihydrate – a stabiliser that protects the protein from degradation
- Histidine hydrochloride, monohydrate – a buffering agent
- Histidine – a buffering agent
- Polysorbate 20 – a surfactant that prevents protein aggregation
- Water for injections – the vehicle/solvent
Appearance and Packaging
Lucentis is a clear, colourless to slightly brownish-yellow aqueous solution supplied in a single-use glass vial (0.23 ml). Two packaging configurations are available:
- Vial-only pack: Contains one glass vial of ranibizumab with a chlorobutyl rubber stopper.
- Vial plus filter needle pack: Contains one glass vial of ranibizumab with a chlorobutyl rubber stopper and one blunt filter needle (18G × 1½″, 1.2 mm × 40 mm, 5 µm) for withdrawing the vial contents.
For premature infants, a separate precision low-volume syringe and injection needle (30G × ½″) are provided in the VISISURE kit to ensure accurate dosing of the smaller 0.02 ml volume.
Frequently Asked Questions
Most patients report only mild discomfort rather than true pain. Before the injection, your ophthalmologist applies anaesthetic eye drops (and sometimes an anaesthetic gel or injection) to numb the eye and surrounding area. You may feel a brief pressure sensation during the injection itself, which typically takes only a few seconds. Some patients experience mild soreness or a gritty feeling for a few hours afterwards, which usually resolves quickly. If you are anxious about the procedure, discuss this with your doctor – additional comfort measures can often be arranged.
The entire appointment, including preparation, the injection, and post-injection monitoring, typically takes 30 to 60 minutes. The injection itself lasts only a few seconds. Before the injection, the eye area is cleaned with antiseptic solution and anaesthetic drops are applied. After the injection, your intraocular pressure may be checked and you will be monitored briefly before being discharged. You should arrange transport home, as your vision may be temporarily blurred.
It is generally not recommended to drive immediately after receiving a Lucentis injection. The anaesthetic drops, antiseptic wash, and the injection itself can cause temporary blurred vision and light sensitivity that may last several hours. Most clinics advise patients to arrange for someone to drive them home after the appointment. You can usually resume driving the following day, once your vision has returned to normal. Always follow your ophthalmologist's specific advice.
Biosimilars such as Byooviz, Ranivisio, Ximluci, and Rimmyrah contain the same active substance (ranibizumab) and have been rigorously tested to demonstrate equivalent efficacy, safety, and quality compared to the original Lucentis. The regulatory approval process for biosimilars requires extensive analytical, preclinical, and clinical comparisons. The primary difference is typically the manufacturer and the cost, with biosimilars generally being less expensive. Your ophthalmologist can discuss whether a biosimilar is appropriate for your treatment.
Lucentis has demonstrated significant efficacy in treating wet AMD. In landmark clinical trials (MARINA and ANCHOR), approximately 95% of patients treated with monthly ranibizumab maintained their vision (lost fewer than 15 letters) over two years, compared with about 62% of control patients. Furthermore, 30–40% of treated patients gained 15 or more letters of visual acuity, representing clinically meaningful vision improvement. Real-world outcomes have confirmed these results, particularly when treatment is initiated promptly and followed consistently.
The duration of Lucentis treatment varies depending on the condition being treated and your individual response. For wet AMD, treatment is typically long-term and may be needed for many years, as the underlying disease process is chronic. With a treat-and-extend approach, the intervals between injections may gradually lengthen over time if the disease remains stable. For DME and RVO, some patients achieve disease stability and treatment can be paused, though ongoing monitoring remains essential. Your ophthalmologist will tailor the treatment plan to your specific needs.
References
- European Medicines Agency (EMA). Lucentis (ranibizumab) – Summary of Product Characteristics. Last updated 2025. Available at: ema.europa.eu
- Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419-1431. doi:10.1056/NEJMoa054481 (MARINA trial)
- Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432-1444. doi:10.1056/NEJMoa062655 (ANCHOR trial)
- Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789-801. doi:10.1016/j.ophtha.2011.12.039
- Stahl A, Lepore D, Fielder A, et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial. Lancet. 2019;394(10208):1551-1559. doi:10.1016/S0140-6736(19)31344-3
- National Institute for Health and Care Excellence (NICE). Ranibizumab for treating visual impairment caused by macular oedema. Technology appraisal guidance [TA274, TA283, TA346]. Available at: nice.org.uk
- American Academy of Ophthalmology (AAO). Preferred Practice Pattern: Age-Related Macular Degeneration. Updated 2024. Available at: aao.org
- EURETINA. Guidelines for the Management of Neovascular Age-Related Macular Degeneration. Updated 2023.
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd edition, 2023. Geneva: WHO.
- Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010;117(6):1102-1112. doi:10.1016/j.ophtha.2010.02.021 (BRAVO trial)
Editorial Team
This article was written by the iMedic Medical Editorial Team, a group of licensed physicians specialising in ophthalmology, retinal medicine, and clinical pharmacology. All content follows international medical guidelines and is reviewed according to the GRADE evidence framework.
iMedic Medical Editorial Team – Specialists in ophthalmology and pharmacology with experience in retinal disease management and anti-VEGF therapy.
iMedic Medical Review Board – Independent panel of medical experts who verify accuracy, completeness, and adherence to current clinical guidelines (AAO, EURETINA, NICE, EMA).
All medical information is based on peer-reviewed research (evidence level 1A) and current international guidelines. We have no commercial funding or pharmaceutical industry sponsorship. For more details, see our Editorial Standards page.