What are intravitreal injections?
The term intravitreal injection refers to the administration of therapeutic preparations into the eyeball. The administration of an injection into the vitreous humour is a short and painless procedure, performed under local (eye drop) anaesthesia in an outpatient setting. Before the injection, we conduct full ophthalmological diagnostics, and, on the basis of the achieved results, we qualify for treatment. Intravitreal injections are used in the treatment of diseases of the posterior pole of the eye. This is a modern, and currently the most effective method of treatment in the case of exudative age-related macular degeneration (AMD). Such procedures also find use in the treatment of diabetic macular edema, macular complications of pathological myopia, and macular edema resulting from central retinal vein occlusion.
What medications are used in intravitreal injections?
Currently, we use various therapeutic preparations, anti-VEGF, i.e. Avastin (bevacizumab), Lucentis (ranibizumab), Eylea (aflibercept). For the first 3 months of treatment, intravitreal injections are usually administered every 4 weeks, and then the frequency of injections depends on the type of disease, therapy efficacy and the type of the medication used (usually every 4 or 8 weeks, or even less frequently in certain cases). Steroid drugs are used much less frequently at our Centre. We use VITREAL S (triamcynolon) e.g. in the treatment of diabetic macular edema, retinal vessel thrombosis and inflammatory processes in the retina and choroid. These medications have an antiedema and antiinflammatory effect.
What are the indications for treatment with intravitreal injections?
belongs to major causes of irreversible loss of central vision in adults, and is a serious medical and social problem. AMD is a chronic disease, and may occur in two forms: dry (atrophic) and exudative (wet, neovascular). The course of dry AMD, which occurs in approx. 90% subjects, is usually slow, long-term and leads to a gradual loss of sight. It may, however, transform into the exudative form, which often causes rapid vision deterioration, and, if untreated or treated too late, leads to significant, irreversible loss of vision. The exudative form is an URGENT indication for treatment by means of intravitreal injections.
is one of the major factors of vision loss and significant visual acuity deterioration in developed countries. The most common cause of CRVO is vascular injury. The cause of venous occlusions is always general diseases, such as hypertension, atherosclerosis or diabetes. In young patients, aged 35-50, they may be caused by inflammatory diseases, e.g. vascular inflammatory diseases. It is vascular abnormalities that are responsible for the formation of occlusion, as well as for heart attack or stroke. Therefore, to treat such diseases, a complete diagnosis of an internal medicine specialist or cardiologist is necessary. Eye occlusion always results in vision deterioration, and the degree of eye damage depends on the size of the occlusion. Normally, to save eyesight, ophthalmological treatment must be conducted together with general treatment, and includes laser, injections of anti-VEGF medications, and steroids. Sometimes surgical treatment is necessary. vitrectomy.
is the main cause of impaired vision in subjects with type 2 diabetes. The basic aim of the therapy is to inhibit the progression of pathological lesions in the macular region and to maintain the best possible visual acuity. Treatment includes intravitreal injections (anti-VEGF and steroid preparations), laser treatment and surgical treatment. The choice of treatment method depends on the advancement of diabetic maculopathy. Diabetic macular edema (DME) is a serious complication of diabetes mellitus which (if not adequately treated) leads to significant, permanent vision deterioration.
involves a formation of new, abnormal blood vessels in the choroid, which produce fluid causing eye edema. Patients with choroidal neovascularisation secondary to myopia, reveal such symptoms as blurred vision (metamorphopsia), image distortion and/or presence of white or grey spots in the centre of the visual field (scotomas). Choroidal neovascularisation is a serious eye disease, which, if untreated, may lead to a loss of vision. Without treatment, the majority of people affected by this disease will be blind within 10 years of the diagnosis.
At the Eye Surgery Centres of Professor Zagórski, we have been conducting diagnostics and treatment of patients with macular diseases for many years. Having access to modern equipment, we can diagnose early and adequately treat patients with retinal problems. We perform all necessary examinations, e.g. OCT (optical coherence tomography), fluorescein angiography, indocyanine angiography, angio-OCT. Our staff members have extensive experience supported with long-term practice and participation in numerous ophthalmological congresses, scientific conferences, courses and trainings in the country and abroad. We offer our patients with prompt diagnosis and treatments at the highest international level.
It depends on the type of disease which we treat. In the case of AMD (exudative form), there is no other treatment method. In the case of macular edema secondary to diabetic retinopathy, or after central retinal vein occlusion, we might consider treatment with micropulse or yellow laser, or surgical treatment? posterior vitrectomy. The treating physician will discuss details with you.
Yes. The aim of treatment is to inhibit the disease progression, which does not necessarily mean improvement in seeing. Sometimes, especially with advanced lesions, the treatment is introduced in order to stop further deterioration of vision.
It is difficult to give a decisive answer, since it depends on the type and advancement of the disease we treat, and on the way the patient responds to therapy. We usually start with a monthly administration of anti-VEGF antibody, and if that does not help, we consider switching to another medication with a different target? details with be discussed by the treating physician.
No. Before injection, we use topical anaesthetic drugs in eye drops. Sensitive subjects may feel discomfort resulting from the application of a speculum supporting the eyelids. Some patients may have slight pricking sensation when the needle goes through the eye wall.
The injection alone lasts about 1-2 minutes. More time is needed for the examination before the injection, and preparation for the drug administration at the operating theatre, so you must reserve about an hour for the stay at the centre.
After the injection, a dressing is applied which must be removed after reaching home. You may obtain a prescription for antibiotic drops, which are usually applied into the eye a few times a day – details will be provided by the treating physician. They are also written down in the information card which you will receive when leaving the Centre after the injection. The card also includes the date of the next visit.
Complications after the injection are fortunately extremely rare. These may include swelling on slight redness at the injection site, which will disappear within a few days. The most serious complication, although extremely rare, is an inflammatory response (endophthalmitis) after the administration of the drug. This condition requires immediate surgical treatment; therefore, in the event of sudden pain or loss of vision, you must immediately contact the Centre. An early diagnosed inflammation may be effectively treated.
The procedures of intravitreal injections are performed at OCHO at least once a month.
At OCHO, injections are usually performed as commercial procedures. It is also possible to obtain financing from the National Health Fund as part of drug programmes. In order to qualify for a drug programme, one must meet medical criteria specified by the Ministry of Health, and be verified by the central qualification committee. After qualification, the patient is included in the waiting list for introduction to the treatment programme.
You must bring your identity document for the procedure.
The injection procedure is carried out in an outpatient setting, which means that the patient may go home directly after the procedure.
You should not drive vehicles after an intravitreal injection.
Pregnant women can undergo the procedure of intravitreal injections only in emergency situations. In stable cases and after consulting a doctor, the procedure may be postponed.
Qualification for the first injection (examination includes OCT)
Qualification for the next injection (examination includes OCT)