Intravitreal Injections

What is an intravitreal injection?

An intravitreal injection is given through the white part of your eye into the jelly (called vitreous) that fills the inside of your eye. Special drugs injected into the jelly spread to the retina (inner layer at the back of your eye) and other structures in your eye.

Your surgeon will assess and tell you if an intravitreal injection is suitable for you. However, it is your decision to go ahead with the procedure or not.

Types of intravitreal injections:

AVASTIN

AvastinTM was not initially developed to treat eye conditions. Based upon the results of clinical trials that demonstrated its safety and effectiveness, AvastinTM was approved by the Food and Drug Administration (FDA) for the treatment of metastatic colorectal cancer. Once a device or medication is approved by the FDA, physicians may use it “off-label” for other purposes if they are well-informed about the product, based on its use on firm scientific method and sound medical evidence, and maintain records of its use and effect. Ophthalmologists are using AvastinTM “off-label” to treat AMD and other macular pathology.

OZURDEX is a disposable injection device containing a rod shaped implant. It contains dexamethasone. Its effect last for upto 180 days and it has been approved by the FDA.

LEUCENTIS is an Anti VEGF medication; it is a monoclonal antibody fragment and is approved by FDA.

TRIAMCINOLONE ACETONIDE is a Steroid. It is an off label drug. Its effect lasts up to 120 days.

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What are the benefits of an intravitreal injection?

The most common reason for needing an intravitreal injection is to treat wet age-related macular degeneration. It may also be needed for macular edema caused by factors such as diabetic retinopathy, vascular occlusion, inflammation, trauma or surgery, dystrophy etc (macular pathology)

The macular is a specialised area of the retina responsible for visual sharpness. Retina converts the light entering your eye into images that are sent to your brain.

An injection of an anti-vascular endothelial growth factor (anti-VEGF) /steroid into the jelly can help to treat macular pathology. You usually need a course of injections over a year or longer for the treatment to be effective.

Are there any alternatives to the injection?

Laser treatment may be suitable for you but is less effective than an intravitreal injection.

What will happen if I decide not to have the injection?

Your vision is likely to get worse. If your retina becomes scarred or you leave the problem for too long, you may get permanent reduced vision in the affected eye.

What does the procedure involve?

The healthcare team will carry out a number of checks to make sure you have the procedure you came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your name and the procedure you are having. The healthcare team will ask you to sign the consent form once you have read this document and they have answered your questions.

You will need to lie still and flat during the injection. If you cannot lie still and flat, let your surgeon know.

The injection is usually performed under a local anaesthetic given as eye drops. The injection usually takes about 30 seconds. Your surgeon will also place drops of an anti-bacterial solution and an antibiotic on your eye. Your surgeon will insert a fine needle through the white part of your eye (sclera) and inject the injection into the jelly in the centre part of your eye. It is normal for your eye to feel slight discomfort during the injection, but due to local anesthesia generally there is very little or no pain.

Please inform your surgeon if you are Pregnant or there is infection.

What complications can occur?

  • Slight Pain (risk 1 in 20)
  • Bleeding: Any bleeding is usually little and your eye may be slightly red.
  • Heavy bleeding: heavy bleeding inside the jelly (vitreous haemorrhage) during the injection, which may cause loss of vision (risk: less than 1 in 1,000)
  • Raised pressure in your eye
  • Retinal detachment
  • Damage to the lens that causes a cataract
  • Inflammation in your eye

How soon will I recover?

After the injection you will be transferred to the recovery area where you can rest. Your eye may feel uncomfortable but this usually settles within a few hours. You should be able to go home after about an hour.

Most people will need one to two days off work.