Anti-VEGF injections are the primary treatment for wet age-related macular degeneration, diabetic macular edema, and retinal vein occlusion. Four agents dominate clinical practice in India: Aflibercept (Eylea), Ranibizumab (Lucentis and biosimilars), Bevacizumab (Avastin), and Brolucizumab (Pagenax). Each differs in molecular size, dosing interval, available Indian brands, and cost per injection. The right choice depends on disease activity, treatment history, and the patient’s capacity for follow-up visits.

According to Dr. Mayank Bansal, a leading retina specialist at the Best Eye Hospital in Delhi, “No single anti-VEGF agent is universally superior. We individualise the choice based on OCT fluid activity, the patient’s ability to attend follow-up, and the cost burden over a full treatment course, not just per injection.”

How Do the Four Anti-VEGF Agents Compare?

All four agents block vascular endothelial growth factor to reduce abnormal vessel growth and retinal fluid leakage. The differences lie in molecular structure, binding affinity, dosing frequency, and price.

The cost figures above reflect Indian market pricing and vary by centre. Annual treatment cost depends heavily on how many injections the treat-and-extend protocol requires for that individual patient. For the full procedure and drug options available at Claritas, Read our blogs on eye injections.

Which Agent Is Used for Which Condition?

Drug selection is not simply brand preference. Disease type, treatment history, and individual OCT response all feed into the decision.

• Wet AMD with high fluid burden: Brolucizumab and Aflibercept both show strong fluid reduction on OCT. Brolucizumab’s higher molar concentration per dose gives it an edge in patients with persistent subretinal or intraretinal fluid after multiple prior injections with earlier agents.
• Diabetic macular edema: Aflibercept holds strong trial data for DME, particularly in patients with baseline vision of 20/50 or worse. Ranibizumab biosimilars like Razumab are cost-effective alternatives for patients requiring frequent injections over several years.
• Retinal vein occlusion: Both Aflibercept and Ranibizumab carry regulatory approval for branch and central RVO in India. Bevacizumab is widely used off-label given the high injection burden in RVO during the first year of treatment.
• Cost-sensitive patients: Bevacizumab remains the most accessible option at Indian public hospitals and tier-2 centres. Its off-label status does not reduce its real-world efficacy, but patients should receive it only from a surgeon who can compound and administer it under sterile conditions.
• Treatment-naive patients with good follow-up: Aflibercept or Ranibizumab are the standard starting choices, with a switch to Brolucizumab considered when OCT-guided treat-and-extend protocols show persistent fluid at 8-week intervals.

Across all four agents, the decision comes down to OCT disease activity and the patient’s ability to attend follow-up. The agent matters less than the monitoring protocol behind it. For a full overview of conditions treated with these agents, the macular degeneration treatment page covers AMD-specific protocols. 

Why Choose Dr. Mayank Bansal ?

Dr. Mayank Bansal is MD (AIIMS), FRCS (Glasgow), FACS, with a retina fellowship at UCLA. Over 15 years of vitreoretinal practice managing wet AMD, DME, and complex retinal vein occlusion with all four major anti-VEGF agents. OCT-guided treat-and-extend protocols are used across all injection patients to minimise total injection burden while protecting vision. International patients receive full support including scheduling, accommodation coordination, and discharge summaries formatted for handover to their ophthalmologist abroad.