Drug applications into the eye (intravitreal) are injecting medication near to retina behind the eye. Inside the eye is filled with jelly-like fluid as the patient is bothered by certain symptoms due to a problem with leakage, swelling, or bleeding in the retina at the back of the eye. The medication during this procedure can cure certain eye problems and help preserving the eye sight. This method is usually used to inject higher levels of medication into the retina.
What are the Drug Applications into the Eye (Intravitreal)?
Drug applications into the eye (intravitreal) or intravitreal injections are the procedure of injecting medication in order to cure various retinal conditions. Age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusion are the most common conditions treated with intravitreal anti-VEGF drugs. In some eyes that have diabetic retinopathy, retinal vein occlusion and uveitis, intravitreal steroids are used.
Anti-VEGF drugs and steroids help reducing the fluid leakage relevant to these diseases. Antibiotic, antifungal and antiviral drugs are used to cure patients who have eye infection such as endophthalmitis and retinitis. In some situations, injection is used to place a tiny gas bubble in order to help repairing retinal detachment.
Which Department Deals with Drug Applications into the Eye (Intravitreal)?
Drug applications into the eye (intravitreal) is the procedure of filling a drug directly behind the eye, called the vitreous cavity, with a jelly-like fluid called vitreous humor gel. The procedure is usually performed by an educated retina specialist in office environment. Drug applications into the eye (intravitreal) are performed in eye clinics.
How to Perform Drug Applications into the Eye (intravitreal)?
The procedure of drug applications into the eye (intravitreal) lasts about 15 to 30 minutes. The steps of this procedure are:
- Drops are dripped in the eyes to dilate the pupils.
- The patient lie face down in a comfortable position
- Eyes and eyelids are cleaned.
- Anesthetic drops are dripped.
- A tiny tool keeps the eyelids open during procedure.
- The other eye is invisible.
- The drug is injected into the eye with a small needle. The patient can feel pressure but not pain.
- Antibiotic drops are placed in the eye.
Drugs injected into the eye usually give the best result when given on more than one occasion. Depending on the eye’s reaction to the treatment, re-injection will probably be needed in a month or a few months. The injection is made with a very fine needle through the white part of the eyeball.
Drug Applications into the Eye (intravitreal)
The drug types given on the drug applications into the eye (intravitreal) procedure are:
- Anti-VEGF drugs
- Steroids reducing inflammation
- Antibiotics, antiviral and antifungal drugs
The intravitreal injection is an indispensable tool for a retina specialist to treat various conditions. In 2006 since the anti-VEGF drugs’ launch, their use has become more common. AMD, requires frequent examination, intravitreal injections need to be repeated frequently in chronic conditions such as diabetic macular edema and retinal vein occlusions. Repeated injections are usually tolerated in a few years. The need for re-injection is usually determined, during the clinical examination, with the use of:
- Optical Coherence
- Tomography (OCT)
- Diagnostic Tests Like Fluorescein
- Angiography (FA)
Before the treatment your doctor will discuss the other treatment options and explain all the advantages and disadvantages of the treatments presented to you. These treatment options will change depending on:
- The reason of the eye problem
- The location of the leakage in the retina
- Other treatments you have had and how your eye is responding to these treatments
- Whether you have had cataract surgery
- Whether you have glaucoma
What are the Advantages of Drug Applications into the Eye (intravitreal)?
The advantage of the drug applications into the eye (intravitreal) is the the immediate increase and decrease therapeutic effect on the aimed retinal tissue. The accuracy, precision, and repeatability of the delivered volume depend on the size of the syringe and the doctor's manual experience. Intravitreal drug injections are usually highly effective treatments and many patients benefit from the treatment.
Naturally, like all the other treatments, the intravitreal injection treatment can cause side effects although not seen in everyone. The side effects of these treatments can be caused from either the drug itself or the injection procedure. Most of the side effects include the eye. Common side effects include discomfort during and after the injection, bruising in the white of the eye, increase on the eye pressure and moving black dots in your sight.
The Process After the Drug Applications into the Eye (Intravitreal)
Serious complications in the drug applications into the eye (intravitreal) or intravitreal injections are rare. The main risks are:
- Infection in the eye or endophthalmitis
- Eye inflammation or pseudoendophthalmitis, which is a non-infectious inflammatory reaction to certain drugs
- Vitreous bleeding
- Retinal detachment
- Blockage of the main artery to the eye
- Detachment of the retina
Sometimes, in the surface where the needle goes it can be little bleeding or subconjunctival hemorrhage. This usually heals within a week. The retina specialist, after the injection, can control the intraocular pressure. There is usually a transient increase in intraocular pressure that returns to baseline within a few minutes. For the patients with glaucoma, intraocular pressure to back to normal can be longer and needs to be checked.
There is no restriction on the injection day when following the injection besides preventing possible contamination of the eye. At the same time, it needs to be consulted to a retina specialist if there are complication signs and symptoms like the below mentioned:
- Eye pain or discomfort
- Increasing on seeing floaters after the first day
- The increasing sensitivity on light
- The decreasing sight
Sometimes after the intravitreal injections the patient can get the feeling as if there is something in the eye. This can be a reaction to the povidone iodine used in order to clean the eye before the injection. Artificial tears, preferably sterile disposable drops, can use to help to relieve surface irritation symptoms and dryness. The retina specialist schedules a follow-up visit depending on the treated disease but this visit is usually scheduled for about 4 to 6 weeks after injection.
At the same time, depending on the injected drug, a follow-up appointment is made at the clinic for review or further injections. This can vary depending on the disease and is explained in more details in the consultation. It is normal for eyes to feel slightly gritty, uncomfortable, or watery and the white of the eye can be red for a day after the injection. This must be dealt within 2 days.
Since the expanding drops will blur the eye-sight after the injection, you should not drive. After the injection the eye should not be rubbed. Because of the anesthetic drops there is risk of scratches on the eye surface. The eye should be cleaned or wiped gently using a clean tissue. Every time when the eye is cleaned, the used tissue should be thrown away and a new tissue should be used.
Water, shampoo, or soap should not touch the eye 48 hours after the injection. Also, 48 hours after injection swimming should be avoided. After the injection if the eye feels gritty, lubricating dry eye drops may help the eye feel more comfortable. A new vial can be used after each injection to minimize the risk of infection in the eye.
Some patients notice floaters or shadows in the treated eye immediately after injection. These need to disappear gradually within the next 2 days. With some medications, it will take several weeks for the shadows and floaters to disappear.