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Intravitreal Injection

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What is an intravitreal injection?
An intravitreal injection is an injection of a drug into the vitreous body (the jelly in the eye). It is given through the sclera (the white of the eye).

Why do I need intravitreal injection?
The aim of intravitreal therapy is to improve or stabilise your vision. These injections may not restore vision that has already been lost and it may not prevent further loss of vision, caused by the disease. The drugs most commonly used are anti-VEGF agents: Ranibizumab (Lucentis), Aflibercept (Eylea) and Bevacizumab (Avastin). In wet macular degeneration and diabetes these drugs slow or stop the growth of abnormal blood vessels, and leakage in the back of the eye (retina).

They are also used following a blocked blood vessel (retinal vein occlusion) in the eye. Anti-inflammatory drugs (steroids) such as Ozurdex are used to reduce swelling of the retina, diabetic macular oedema, retinal vein occlusion and ocular inflammation (uveitis).

Where does the procedure take place?
Injections are performed as an outpatient procedure, either in the Eye Clinics procedure room or Treatment Centre. You will be given the date, time and exact location by letter or telephone call before your treatment. These injections will be administered by a doctor or a nurse (please note there may be variation of techniques used). Please expect to be in the department for approximately two hours the procedure takes about 20 minutes.

How do I prepare for the procedure ?
• Make sure you understand why you are having eye injections along with the potential risks of the procedure.
• Do not wear eye make-up/false eye lashes or contact lenses on the day of procedure.
• Inform the doctor/nurse if you regularly use eye medication.
• Advise of any infection or inflammation on or around the eye.
• Mention any allergies.
• Inform the doctor/nurse of any blood thinning medication e.g. Warfarin, Aspirin, Clopidrogel, Apixaban or Riveroxiban.
• Please mention to the Doctor any heart attacks or strokes in the last 3 months, or any uncontrolled high blood pressure and uncontrolled angina.
• Do not drive on the day of your appointment.
• Bring a relative, carer or friend with you, but please be aware they will not be allowed into the procedure room whilst you are having your injection.

What does the procedure involve?
You will have local anaesthetic drops to numb the eye. The skin around your eye will be cleaned with an iodine-based antiseptic solution and some antiseptic eye drops (povidone iodine) will be used before the injection of the drug, to reduce the risk of infection. Your face and the area around your eye will be covered by a drape (a small surgical sheet) to keep the area sterile. A speculum (a small clip) will be used to keep the eye open. As the drug is injected it is important you keep as still as you can and you will be told in which direction to look.

Will the injection be painful?
Although the surface of the eye will be numb from the anaesthetic drops you will probably notice a slight pressure when the needle is entering the eye, similar to that of a blood test. Any discomfort experienced will depend on various factors as some individuals may be more sensitive than others. The speculum used to keep the eye open may cause a pressure sensation and discomfort in some patients.

Risks of treatment and side effects?
As with any medical or surgical procedure there is a small risk of complications following intravitreal injections. For most patients the benefit of the treatment outweighs the risks.

Common side effects include:
• Normal side effects include dots, bubbles, shadows or floaters (which may be different colours) and may last a couple of days.
• You may experience a pain or ache in the eye please take over the counter pain medication as necessary.
• Your eye maybe red or blood shot. This can look dramatic but is nothing to worry about.
• Sore and gritty eye.

Serious but rare complications include:
• Retinal detachment.
• Endophthalmitis an infection within the eye, (one in 2,000 cases).
• Increased pressure in the eye.
• Bleeding inside in the eye.
• Increase the chances of cataract.

Summary
• The aim of the intravitreal therapy is to stabilise or improve your vision.
• The outcome depends largely upon your individual eye condition. Your eye condition may not get better or may become worse despite these injections.
• Injections into the eye are generally safe procedures.
• Side effects may happen and some may be serious. Additional procedures maybe needed to treat these complications.
• Each injection carries similar risks of developing any of the side effects or complications described.
• You must keep to the scheduled treatment and monitoring appointments so that staff can check the response to treatment and complications.
• It is not guaranteed that a particular individual will perform the procedure. The doctor/nurse will have the appropriate training and experience.