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Intravitreal Injections Information

What is an Intravitreal Injection? [ top ]

This is an injection into the vitreous, which is the jelly-like substance inside your eye. It is performed to place medicines inside the eye, near the retina.

Why is an intravitreal injection performed? [ top ]

Intravitreal injections are used to deliver drugs to the retina and other structures in the back of the eye, thus avoiding effects on the rest of the body. Common conditions treated with intravitreal injections include diabetic retinopathy, macular degeneration, retinal vascular diseases and ocular inflammation.

What is the intravitreal injection procedure? [ top ]

Once your pupils are dilated, the actual procedure takes around 15 minutes. We will lie you in a comfortable position and anaesthetic (numbing) drops will be placed in your eye. Your eye and eyelids will also be cleaned with an iodine antiseptic solution. The eye is then held open with an instrument (speculum) and the medicine is injected into your vitreous. You may feel slight pressure on the eye when this is done, but you should not experience pain. After the injection procedure the doctor will check your eye. Some antibiotic ointment will be placed in your eye before you leave. You can have the eye padded for your greater comfort, but this is not essential.

What are the side effects? [ top ]

After the injection into your eye you may have a gritty feeling in the eye, and there may be bleeding over the white of the eye which can be quite marked. You should not worry about this, it will resolve with time. You might see floaters; these will become smaller and disappear over a couple of weeks.

Are there any risks? [ top ]

Injecting any medication into the eye may result in increased pressure within the eye, inflammation, or more serious side effects such as bleeding within the eye, damage to the retina (retinal detachment or tear) or other eye structures. These side effects are rare, estimated at less than 1 in 500 injections. It is possible that you may get an infection within your eye (endophthalmitis) as a result of the intravitreal injection. The chance of an infection is low however, and is estimated at about 1 in 400 injections. An infection may lead to vision loss or, in rare cases, loss of the eye. Infections can be treated with a good result as long as you return quickly (preferably the same day) if you notice something going wrong. Symptoms to look for include a severe loss of vision, pain, and/or inflammation which does not resolve within a day of the injection. If Eye Associates is not open, go to the Sydney Eye Hospital Emergency Department, which is open every day including weekends and public holidays.

Risks associated with triamcinolone [ top ]

If the drug to be injected into your eye is triamcinolone, there may be long term side effects about which you should be aware. The main possible problems are that triamcinolone may cause an increase in eye pressure (glaucoma) or cataract (clouding of the lens). Elevation of the eye pressure does not cause glaucoma if it is controlled with eye drops. The pressure in your eyes will be checked at every visit and eye drops will be prescribed if the pressure increases significantly, which it does in around 30% of eyes. Mostly these drops can be discontinued after six months. Cataracts are not a serious problem for the first few months after the injection, but over 50% of treated eyes will develop significant cataract after twelve months if triamcinolone has to be given more than once. We have established that removal of this cataract is safe in eyes with macular oedema as long as another injection of triamcinolone is given around the time of cataract surgery.

What else do I need to know? [ top ]

Please allow at least 1 hour for your appointment. This will allow dilation of your pupils, the injection, and review afterwards by your doctor.

You will need to be reviewed one to two weeks after your injection.

Preparation for the test. [ top ]

It is very important for you to tell us about any health conditions that you have, all the medications that you are taking, and especially any allergies to medications that you have had in the past.

You will be asked to sign a consent form on the day of your appointment.

Patient Information for Lucentis [ top ]

Lucentis is a drug that has been developed to treat the disease called age-related macular degeneration (AMD). You have been diagnosed with AMD and therefore your doctor has considered using this drug for your treatment. AMD is a progressive condition in the eye which, if left untreated, may cause you to lose the central vision in your eye(s) because the central part of your retina (the film in the back of your eye) is swollen. This swelling is caused by abnormal blood vessels growing in the retina that are very fragile and therefore leak blood and fluid. It is this fluid accumulation and swelling that is mostly responsible for your vision loss. Lucentis blocks a molecule that is involved in the growth of new blood vessels as well as their leakage. Before you are treated with Lucentis, you need to know the risks and benefits so you can make an informed decision. This “Patient Information Sheet” provides you with information about the drug Lucentis. Please read this information carefully and discuss it with anyone you wish. This may include your doctor, a friend or a relative. If you have further questions regarding your treatment options, we suggest you consult your doctor who knows your clinical history and is best able to advise you on the risks and benefits of treatments.

Lucentis is a compound that is given by injection into the eye. It has been used in clinical trials to treat more than 900 patients who have AMD. Lucentis has been available with prescription on the Pharmaceutical Benefits Scheme (PBS) since August 2007. Before this date it cost the patient $2000 per dose, now it costs a maximum of $30.70 on the PBS or $4.90 for concessional patients.

The treatment of your affected eye will be performed according to your doctor’s advice. The treatment takes around 10 minutes and you will lie in a reclining chair or on a bed. A small device (speculum of eyelid clamp) will keep your eyelids open. The conjunctiva or skin over the white part of your eye will be anaesthetised with a small injection. The Lucentis will then be injected into the vitreous jelly inside your eye. You may feel slight pressure.

While you receive this treatment you may have any, or none, of the side effects described below. Problems or side effects that are not yet known could also occur. Many side effects go away shortly after you discontinue therapy, but in some cases, side effects can be serious, long lasting, or permanent. Should any problem occur, you will be given appropriate care for your condition and you may be withdrawn from further treatment.

Risk of Injection into the Eye

After the injection into your eye, you may have a foreign body feeling in the eye and there might be mild redness or bleeding in the conjunctiva due to the anaesthetic injection. These will resolve over a few days.

Injecting any medication into the eye may result in increased pressure within the eye, inflammation, or more serious side effects such as cataract formation, bleeding within the eye, damage to the retina (retinal tear or detachment), or damage to other eye structures. These side effects are rare, estimated to be around 1 in 1000 injections.

It is possible that you may get an infection within your eye (endophthalmitis) as a result of injection into the eye. The chance of infection is low (estimated at 1 in 900 injections). An infection may lead to vision loss or, in rare cases, more serious events. Procedures will be done to minimise the risk of infection, such as the use of antibiotics.

Bleeding Associated with the use of Anticoagulant Medication

The use of certain kinds of anticoagulant (blood-thinning) medications (e.g. aspirin) is permitted during this treatment. However, these types of medication are known to increase the chance of bleeding and could possibly increase the chance of internal eye bleeding during treatment if you have an eye inflammation. Inform your doctor if you need to take anticoagulant (blood-thinning) medications (e.g. aspirin) during your treatment with Lucentis.

The risks to an unborn human foetus or a nursing child from Lucentis are not known. Women who were pregnant or nursing a child did not participate in any of the clinical trials. You must confirm that, to the best of your knowledge, you are not now pregnant and that you do not intend to become pregnant during treatment. If there is any possibility that you may become pregnant during treatment, you must inform your doctor. Your doctor will discuss appropriate birth control measures with you. If you suspect that you have become pregnant during treatment, you must notify your doctor immediately.

Benefits of the Treatment

There is no guarantee that you will receive any benefit from the treatment received. However, results from clinical trials in over 900 patients have shown that vision remained stable or increased in over 71-77% of patients being treated with Lucentis. Further, vision increased in 25-40% of patients treated with Lucentis such that they were able to read 3 lines or more of the reading chart (that you are normally tested with) than before they started the treatment. Ask your doctor to explain these results to you. Your doctor can share with you more information about the results of the Lucentis clinical trials that have made him/her propose treating you with this drug.

General Ophthalmology

Subspecialties

Glaucoma
Cataracts
Cornea
Pterygium
Retinal Vein Occlusion
Macular Degeneration
Diabetic Eye Disease
Uveitis
Ocular Pain

Associated Sites

Glaucoma Australia
AMD Alliance
Vision Australia
Guide Dogs Association (NSW)
Stepping Out with Confidence (Western Australian Blind Assoc)
Seeing Eye Dogs Assoc.
The Fred Hollows Foundation

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