Dr. Diva Kant Misra

What are intravitreal injections used for? 

Intravitreal injections are used to administer medications to treat a variety of retinal conditions. Age-related macular degeneration (AMD), diabetic retinopathy and retinal vein occlusion are the most common conditions treated with intravitreal anti-VEGF drugs. Intravitreal steroids are used in some eyes with diabetic retinopathy, retinal vein occlusion and uveitis. The anti-VEGF drugs and steroids help to reduce fluid leakage associated with these disorders. Antibiotic, anti fungal and antiviral drugs are also used to treat patients with infections in the eye such as endophthalmitis and retinitis. In some cases an injection is used to insert a small gas bubble to aid repair of a retinal detachment.

What kind of drugs can be given by intravitreal injection?

• anti-VEGF drugs
• Steroids, which reduce inflammation
• Antibiotics, antiviral and antifungal medications

The intravitreal injection procedure 

Intravitreal injections are performed in the office, often with the patient reclined in a chair. First, the eye and eyelids are anesthetized using drops or gel so the injection doesn’t hurt. Sometimes a small numbing injection may be given. 

The eye and the eyelids are then cleaned, usually using povidone-iodine, a yellow solution which is very effective at killing bacteria that live around the eye.  An eyelid speculum is often used to keep the eyelids open during the procedure. Once the eye is prepped for injection, you will be asked to look in a particular direction depending on the location of the injection while the medicine is injected through the pars plana (the white part of the eye) with a very small needle.

Typically, patients feel pressure, with little or no pain during the injection. After the injection, the speculum is removed and the eye is cleaned. The entire process takes about 10 to 15 minutes.

Safety and results 

Severe complications are very rare with intravitreal injections. The major risks are:

• Infection in the eye or endophthalmitis
• Inflammation in the eye or pseudoendophthalmitis (a non-infectious inflammatory reaction to some medications)
• Bleeding into the vitreous gel (vitreous hemorrhage)
• Retinal detachment

Sometimes there may be a small bleed or subconjunctival hemorrhage on the surface of the eye where the needle enters; this usually heals within a week.

Your retina specialist may check the intraocular pressure (IOP), that is, the pressure within the eye, following the injection. There is a temporary rise in IOP that usually returns to baseline in a few minutes. The IOP may take longer to normalize in patients with glaucoma and needs to be monitored.