Anti-VEGF Eye Injections in Delhi: Eylea, Ranibizumab, Pagenax, Vabysmo, or a Biosimilar?
When patients hear they need an injection in the eye, the questions come quickly. What is this injection? Why do I need it? Which one should I choose? And how much will all of this cost? Let's take these one at a time and clear up some myths along the way.
One thing first: the price of a single injection is rarely the number that matters. Most eye conditions that need these injections need more than one. So it's wise to think about what a year of treatment costs, not a single visit.
What Are Anti-VEGF Injections, and Why Would I Need One?
VEGF stands for vascular endothelial growth factor. It's a signal the body uses to grow new blood vessels. In certain retinal diseases, this signal goes into overdrive, and fragile new vessels start growing where they shouldn't. These vessels leak fluid and bleed. Anti-VEGF drugs (literally, "against VEGF") block that signal, so the leakage and swelling settle down.
The most common conditions we treat with these injections are:
Diabetic retinopathy and diabetic macular edema. Diabetes damages the small vessels of the retina. New vessels can grow and bleed into the eye, or the central retina can become swollen with fluid.
Wet age-related macular degeneration. Medically called neovascular AMD, this is where new vessels grow under the macula. The macula is the central part of the retina we use for reading and recognising faces. The result is often a dark or blurred spot in the centre of vision.
Retinal vein occlusion. A vein in the retina gets blocked, often in people with high blood pressure, and the retina swells.
Ranibizumab, Eylea, Pagenax and Vabysmo Compared
These drugs have evolved over the years. Here's how they compare, roughly in the order they arrived.
Ranibizumab (Lucentis, also sold in India as Accentrix). One of the first drugs made specifically for the eye. Its effect lasts about a month.
Aflibercept (Eylea). Aflibercept acts on two VEGF receptors rather than one, and its effect lasts around two months. It's highly effective in both wet AMD and diabetic macular edema, and we often see the swelling come down almost immediately. A higher-dose 8 mg version has been approved abroad and is expected in India. In trials, many patients on the 8 mg dose went three to four months between injections.
Brolucizumab (Pagenax). Its effect can last about three months. When it first came out, there were reports of inflammation inside the eye after injection. In a multicentre study of Indian patients, this turned out to be less common than first reported, but it's still possible. So if an eye shows any signs of inflammation, it's best avoided.
Faricimab (Vabysmo). The most recent entrant. It works on two pathways, VEGF and Ang-2, and in trials many patients went up to four months between injections. The company claims it also stabilises the blood vessels. In our experience, the drop in swelling may not be as dramatic in the first few days as it is with Eylea.
What Is an Anti-VEGF Biosimilar, and Is It Safe?
Because these drugs are expensive, several Indian companies make biosimilars. A biosimilar is a closely matched version of the original drug. It is not the exact molecule from the original research. Before approval, its effectiveness and safety are tested against the original. Ranibizumab biosimilars have been used in India for about a decade, and aflibercept biosimilars have now arrived too.
Think of a biosimilar as a cost-effective option. It isn't necessarily the first choice, but if cost is a real concern, it's a good one.
What About Bevacizumab, the Low-Cost Off-Label Option?
Bevacizumab, sold as Avastin, is from the same family of drugs. But it was made for colorectal cancer and isn't approved for use in the eye. It's used off-label because one vial can be divided into many eye doses, which brings the cost down sharply. In large clinical trials, it has worked well for both wet AMD and diabetic macular edema.
The catch is in that dividing. When one vial is opened and shared between several patients, the risk of infection inside the eye goes up unless it's handled under strict sterile conditions. That's why many retina surgeons don't prefer it unless cost is the deciding factor. It's more practical in very high-volume centres, where a vial is used up the same day. At our centre, we don't use it at all.
What Eye Injections Cost in Delhi
Here's a rough guide to the cost of a single injection, including the drug and the procedure.
Drug | Typical effect per dose | Approx. cost per injection (drug + procedure) |
Bevacizumab (Avastin) | One month | ₹5,000–8,000 |
Ranibizumab biosimilar | One month | ₹15,000–20,000 |
Ranibizumab (Lucentis/Accentrix) | One month | ~₹30,000 |
Aflibercept (Eylea 2 mg) | Two months | ~₹40,000 |
Brolucizumab (Pagenax) | Three months | ~₹45,000 |
Faricimab (Vabysmo) | Four months | ~₹80,000 |
Approximate Delhi prices as of September 2026. Durations are typical; the actual gap between injections varies from eye to eye. Drug prices in India change; Eylea's price, for example, was cut substantially in 2026.
A drug that costs more per injection but lasts longer may need fewer injections, so over a year the gap between options can narrow. Fewer injections also mean fewer visits, fewer days off work and less travel. It's worth asking your doctor what the whole year is likely to look like for your eye, not just the first injection.
How Many Eye Injections Will I Need?
It depends on the eye and how it responds. For wet AMD, treatment usually starts with a loading phase: one injection a month for the first three months, or four with Vabysmo. After that, scans guide how far apart the next injections can be. Wet AMD often needs ongoing injections, because the disease can be aggressive, and smoking adds to the risk.
In diabetic eye disease, the plan is more flexible. When new vessels are bleeding into the eye, one or a few injections alongside laser treatment may be enough. Diabetic macular swelling usually needs a course of injections before it settles.
If an eye isn't responding well to one drug, we consider switching to another.
It's worth being clear about one thing. These are medicines. While the effect lasts, the swelling and bleeding stay down. But the underlying condition is still there. In diabetics, poorly controlled blood sugar can bring the swelling back, and AMD can come back too. That's not a reason to avoid treatment. When an injection is advised, it's wiser to go ahead with it. The benefits far outweigh the risks.
Do Eye Injections Hurt?
This is the question almost everyone asks before their first injection. Most people describe it as a pinch, or feel no pain at all. The eye is numbed with drops beforehand, and the injection itself takes only seconds.
Afterwards, some people notice a small red patch on the white of the eye or a few floaters. Both are common and settle on their own.
What Are the Risks, and How Do We Reduce Them?
The most important risk is infection inside the eye, and reducing that chance is our top priority. That's why we give injections in an operation theatre setting. Before a planned injection, we ask patients to:
take a head bath before coming in
use antibiotic eye drops for three days
have betadine drops put in on the day
When an injection has to be given as an emergency, antibiotic and betadine drops are put in just before the procedure.
Where the needle goes matters too. The injection is given through a part of the eye called the pars plana, 3 to 4 millimetres behind the limbus. The limbus is the ring where the clear cornea meets the white sclera. If the needle goes in too far forward, it can touch the lens and cause a cataract. Too far back, and it can injure the retina. So it's wise to have these injections given by an experienced retina specialist.
Call your doctor straight away if, in the days after an injection, you notice increasing pain, worsening redness or a drop in vision.
Travelling to Delhi for Treatment?
We see many patients from the US, UK, Australia, the Middle East and Africa for retinal care. If you're planning to travel, keep the loading phase in mind: the first few injections are about a month apart. Some patients plan a longer stay. Others have the first injection here and continue with a retina specialist closer to home. Longer-acting drugs can mean fewer trips, so include travel when you weigh up the total cost.
Choosing the Right Injection
There's no single best injection for everyone. The choice depends on your condition, how your eye responds, how often you can come in, and what you can afford over a full year. We'd rather you make informed choices with the full picture of cost and commitment in front of you than start a treatment you can't continue.
If you or someone in your family has been advised these injections and would like a second opinion, Dr Mayank Bansal and the team at Claritas Eye and Retina are happy to help.
Frequently Asked Questions
What are anti-VEGF eye injections? Anti-VEGF injections block vascular endothelial growth factor, a signal that makes fragile new blood vessels grow and leak in the retina. They are used to reduce swelling and bleeding in diabetic retinopathy, diabetic macular edema, wet age-related macular degeneration and retinal vein occlusion.
How much does an eye injection cost in Delhi? Approximate costs per injection in Delhi, including the drug and procedure, as of September 2026: bevacizumab ₹5,000–8,000; ranibizumab biosimilars ₹15,000–20,000; ranibizumab (Lucentis/Accentrix) about ₹30,000; aflibercept (Eylea 2 mg) about ₹40,000; brolucizumab (Pagenax) about ₹45,000; faricimab (Vabysmo) about ₹80,000. Because most eyes need more than one injection, it is worth discussing the likely cost over a full year with your doctor.
Eylea, ranibizumab, Pagenax or Vabysmo: which injection is better? There is no single best injection for everyone. Ranibizumab (Lucentis/Accentrix) typically lasts about one month, Eylea (aflibercept) about two months, Pagenax (brolucizumab) about three months and Vabysmo (faricimab) up to four months. The choice depends on the condition, how the eye responds, how often you can come in, and cost over a year.
What is an anti-VEGF biosimilar, and is it safe? A biosimilar is a closely matched version of an original biologic drug, tested for effectiveness and safety against the original before approval. Ranibizumab biosimilars have been used in India for about a decade, and aflibercept biosimilars are now available. They are a good, cost-effective option when cost is a concern.
Is bevacizumab safe for eye injections? Bevacizumab was made for colorectal cancer and is used in the eye off-label. It has worked well in large clinical trials, and one vial can be divided into many eye doses, which lowers the cost. However, sharing a vial between several patients increases the risk of infection inside the eye unless it is handled under strict sterile conditions, which is why many retina surgeons prefer approved drugs.
How many eye injections will I need? It depends on the condition and how the eye responds. Wet AMD usually starts with one injection a month for three months (four with Vabysmo), followed by injections spaced out according to scans, and often needs ongoing treatment. Bleeding from diabetic retinopathy may need only one or a few injections alongside laser, while diabetic macular swelling usually needs a course of injections.
Do eye injections hurt? Most people describe an eye injection as a pinch or feel no pain at all. The eye is numbed with drops beforehand and the injection takes only seconds. A small red patch on the white of the eye or a few floaters afterwards are common and settle on their own.
What are the risks of anti-VEGF eye injections? The most important risk is infection inside the eye, which is reduced by giving injections in an operation theatre setting, using antibiotic and betadine drops, and good hygiene before the procedure. Incorrect needle placement can injure the lens or retina, so injections should be given by an experienced retina specialist. Contact your doctor straight away if you notice increasing pain, worsening redness or a drop in vision after an injection.
References
Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119(12):2537–2548.
Diabetic Retinopathy Clinical Research Network; Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193–1203.
Lanzetta P, Korobelnik JF, Heier JS, et al. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet. 2024;403(10432):1141–1152.
Brown DM, Boyer DS, Do DV, et al. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet. 2024;403(10432):1153–1163.
Dugel PU, Koh A, Ogura Y, et al. HAWK and HARRIER: phase 3, multicenter, randomized, double-masked trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology. 2020;127(1):72–84.
VRSI Study Group. Brolucizumab-associated intraocular inflammation in Indian patients. Indian J Ophthalmol. 2024;72(8).
Heier JS, Khanani AM, Quezada Ruiz C, et al. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet. 2022;399(10326):729–740.
Wykoff CC, Abreu F, Adamis AP, et al. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet. 2022;399(10326):741–755.
Phase III study of the aflibercept biosimilar ZRC-3285 versus Eylea in neovascular age-related macular degeneration. Ophthalmol Ther.
Zydus launches biosimilar aflibercept in India. Pearce IP, 19 February 2026.
CATT Research Group; Martin DF, Maguire MG, Ying GS, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364(20):1897–1908.
Goldberg RA, Flynn HW Jr, Isom RF, Miller D, Gonzalez S. An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab. Am J Ophthalmol. 2012;153(2):204–208.
Bayer reduces Eylea price in India by 44%. Pearce IP, 2 April 2026.
Writing Committee for the Diabetic Retinopathy Clinical Research Network; Gross JG, Glassman AR, Jampol LM, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA. 2015;314(20):2137–2146.
Avery RL, Bakri SJ, Blumenkranz MS, et al. Intravitreal injection technique and monitoring: updated guidelines of an expert panel. Retina. 2014;34 Suppl 12:S1–S18.
Comments