Intravitreal Injections
Intravitreal injections are often used to treat a variety of diseases, including macular degeneration, diabetic retinopathy, ocular inflammation, and other complications associated with these conditions, such as cystoid macular edema.
Watch Our Video: Intraocular Injection Appointment
The Intravitreal Injection Procedure
The typical procedure for an intravitreal injection involves using topical anesthetic drops and gel to reduce pain, carefully cleaning the outside of the eye with topical betadine drops and swabs, placing betadine drops directly on the surface of the eye and waiting about 5 minutes to allow completion of the sterilization process, then placing a small lid speculum or prop to keep the lids out of the way, and performing the injection. The injection may feel like a dull ache or pressure sensation for just a few seconds.
The procedure itself is very short as the injection literally lasts just a few seconds. After the injection is complete, a technician will help wash out the surface of the eye to reduce irritation from the betadine. It is common to feel burning and a foreign-body sensation in the eye for several hours.
Preservative-free artificial teardrops may be used if there is discomfort. Rarely, because the patient is touching the eye, a corneal abrasion can develop, which can be quite severe and can cause severe pain and tearing for the first 24 hours. It is best to leave the eye alone in those situations and keep it closed. A lubricant ointment, such as Refresh PM, that can be purchased over the counter, can be utilized to reduce symptoms.
Since the main risk of these injections is the risk of developing an infection (endophthalmitis), it is very important that no fingers or tissues touch the eye or come near the eye for 24 hours. The risk of getting a severe infection in the eye, which can lead to blindness after an injection, is 1 in 5000. Although the risk is low, the consequences of such an infection can be devastating and include complete blindness. Other risks, such as retinal detachment and intraocular hemorrhage, are quite rare. If you develop severe pain or severe vision loss two or more days after an injection, you should immediately contact AVRUC.
Intravitreal Injection Medications
Many medications can be injected into the back of the eye.
Steroid Intravitreal Injections
Steroids were the first medication injected directly into the eye. Preservative-free steroids (preservative-free Kenalog) and steroid implants such as Ozurdex™ or Iluvien™ are used for the treatment of macular edema (swelling) caused by diabetes, retinal vein occlusions, or uveitis (ocular inflammation).
Anti-VEGF Intravitreal Injections
Beginning in 2005, the treatment of wet macular degeneration changed dramatically with the introduction of anti-VEGF medications. Vascular endothelial growth factor, or VEGF, is a very important chemical that is released from retinal cells when there is damage from diabetes, high blood pressure, inflammation, or aging. When we control or block the effects of VEGF, this results in a reduction of blood vessel leakage and stops the growth of new abnormal blood vessels. These are important pathological changes that cause vision loss in conditions such as diabetes, macular degeneration, and retinal vein occlusions.
Anti-VEGF intravitreal injection medications include:
- Bevacizumab (Avastin™)
- Ranibizumab (Lucentis™, Byooviz™)
- Aflibercept (Eylea™, Eylea HD™, Pavblu™)
Although all of these medications can be effective at blocking VEGF, their use may vary depending on your retinal condition, and your physician will determine the most appropriate choice.
Treatment involves injecting these medicines directly into the back of the eye. Like other drugs, the medication works for a few weeks and then wears off. As a result, anti-VEGF injections are given monthly in the beginning. Gradually, over three to six months, the frequency of these injections is reduced based on the response that we see on diagnostic testing using OCT and also based on vision. These treatments are often long-term treatments, meaning that many injections will be done over several years and in some cases for the life of the patient.
Geographic Atrophy Intravitreal Injections
In the last two years, medications for the treatment of a very advanced form of dry macular degeneration, called Geographic Atrophy (GA), have been introduced. This class of medications is called complement factor inhibitors. These include Syfovre™ and Izervay™. These medications can slow the progression of geographic atrophy in dry macular degeneration and buy you time to hang on to your central vision longer period.
These medications are typically given every month and gradually reduced in frequency to about every six months on average for the remainder of the life of the patient. They do not improve your vision, but they can slow down the dry macular degeneration. This is the first treatment for dry macular degeneration that is available. There are risks with such treatment, including ocular inflammation, increased risk of the dry macular degeneration turning wet (which would then require anti-VEGF injections), and intraocular infection.
Intravitreal Injections in Indiana
The retina specialists of AVRUC provide advanced retinal care, including intravitreal injections. With convenient retina center locations in Carmel, Bloomington, Muncie, and Avon, we welcome patients from the greater Indianapolis area, Evansville, Lafayette, Terre Haute, and beyond.
