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Intravitreal Injections

An intravitreal injection is an injection of a small volume of medicine into the jelly-like substance (vitreous humour) in the back of the eye. This is the most effective way to get high concentrations of medicine into the eye. There are several different eye diseases that are treated in this way including wet age-related macular degeneration, diabetic macula oedema, retinal vein occlusion, and severe intraocular infection or inflammation. For most of these conditions repeated intravitreal injections are needed.

Most patients tolerate this treatment well and report only mild discomfort. You will be seated in a reclining chair and drops of local anaesthetic are instilled. Your eye may be covered by a drape. The eyes and eyelids are cleaned. A small clamp will keep the eyelids open during the procedure, and a local anaesthetic will be instilled at the injection site. Your doctor will advise you of the direction to look, and the medicine will be injected with a very fine needle. Often an antibiotic ointment is instilled in the eye.

You may feel pressure but not pain. You may see floaters in your vision which will resolve over time, and a little bleeding can occur on the white of the eye which is normal and will go away. It is recommended that you avoid swimming for at least 3 days, and avoid rubbing the eye for several days too. Grittiness on the day of and for several days after an injection are common and the use of single use (preservative free) lubricants is recommended to avoid any eye infections.

There are risks associated with intravitreal injections, and every effort is made to avoid these. However it is important to be aware that they can arise and if you experience any concerns we would rather you contact us immediately for review. In particular if you experience pain, blurry or decreased vision, sensitivity to light, redness of the eye (compared to immediately after the injection) or discharge from the eye, you should contact us immediately.

What medicine is used in intravitreal injections?

Aflibercept (Eylea), ranibizumab (Lucentis), bevacizumab (Avastin), triamcinolone, dexamethasone (Ozurdex), and vancomycin are used in intravitreal injections.

Without treatment, patients with wet ARMD have an extremely high chance of losing vision. Those who are treated with Eylea, Lucentis or Avastin maintain and sometimes gain vision. These medications are called anti-vascular endothelial growth factor (anti-VEGF) drugs. Once injected into the eye, anti-VEGFs diffuse throughout the retina and choroid. They bind strongly to the VEGF proteins that are responsible for stimulating the development of abnormal blood vessels and leakage, stopping the cause of blurred vision and distortion. Treatment is usually required every four weeks until the macular degeneration is brought under control and then the treatment interval may be slowly increased. Some patients are able to be maintained on treatment each 8 to 12 weeks, but some patients will require ongoing treatment more frequently. Researchers are investigating more long lasting treatments.

Anti-VEGFs are used in the treatment of wet ARMD, diabetic macula oedema, branch or central retinal vein occlusion, and myopic choroidal neovascular membrane. Triamcinolone and Ozurdex are anti-inflammatory drugs used in the treatment of cystoid macula oedema, diabetic macula oedema, and retinal vein occlusion. Ozurdex is an implant the size of a grain of rice containing dexamethasone which is slowly released, lasting longer than triamcinolone in suitable patients. Vancomycin is a potent antibiotic used in an intravitreal setting for the treatment of endophthalmitis, which is a rare but potential side effect of any intraocular surgery and intravitreal injections.

(See also Age-related macular degeneration, Diabetic retinopathy, Retinal vein occlusion, Retinal artery occlusion)

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