Intraocular injections are given all the time. They don’t hurt. Intraocular injections of anti-VEGF medications (e.g. Avastin®, Lucentis ®and Macugen®) are given for the treatment of macular degeneration and also, sometimes, diabetic retinopathy.
Intraocular Injection (Mark Erickson, JirehDesign.com)
A retinal specialist sees a variety of patients with retina disease, but most of the patients have either macular degeneration or diabetic retinopathy. The amount of injections given will continue to rise.
When I first recommend an intraocular injection for treatment, the apprehension is palpable. When I describe the process, the biggest question is really regarding pain and discomfort. A needle in the eye?
The Process
I almost never inject the same day I may recommend an injection; regardless of cause. I think patients need time to digest the reasons for the intraocular injection and to get comfortable about having a needle injected into their eye.
Antibiotics
Infection is a risk. The risk is small, but the effects could be devastating. The the rate of intraocular infection is somewhere around 1:2000. This is comparable to cataract surgery. Prior to anticipated injection, I like patients to receive antibiotic drops 4x a day starting 4 days prior to the injection. We are not sure if this really is effective. Some docs will inject at the same day. It’s not malpractice.
Other possible complications include bleeding, cataract and retinal detachment (very unlikely).
Topical Numbing
Upon arrival to the office. Visual acuity and intraocular pressure are documented. The eye is dilated. We use cotton-tipped applicators dipped in Lidocaine (numbing solution) to numb the eye for about 15-20 minutes.
Topical Antiseptic
Remember, infection is a risk. We place a couple of drops of a povidone-iodine solution (Betadine®) on the eye to act as a microbicide (i.e. kills germs). This, in theory, should further reduce the risk of infection. This is the exact same preparation we use before intraocular surgery.
“Wow” That Didn’t Hurt!
The actual injection is anti-climatic. A wire speculum is placed to keep the lids open. The Betadine® is used again. The injection is delivered straight into the eye (a small, but very sharp needle is key). Done!
Instructions are given to continue antibiotic drops for 4 more days and to call if there is any loss of vision or pain (common signs of infection).
What Does This Mean?
Over time, more and more injections will be delivered for the treatment of macular degeneration and diabetic retinopathy. Intraocular injections have become favorable as it directly delivers the needed medication to the target tissue. In addition, there are several sustained release drug delivery systems; Ozurdex® and Iluvien® are great examples. These will be delivered as “injections” as well.
Remember: No pain.
“Randy”
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=238f7555-c405-4570-b5aa-d1b5f859c03f)
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***
Very well described procedure. I have had quite a few intraocular injections and wish I could have read this first!
My first experience was to have an injection of Avastin the day I was seen in the clinic.
While I am numbed adequately I still feel the last push through the eye but the pain is momentary.
I am given antibiotic drops just before the injection and for 4 days after.
I have had about 20 injections and never had an infection. I have had some side effects from the Avastin but have other health issues that may have intensified things.
I don’t regret a single injection as my vision has been preserved . At first I thought I was going to go blind ~ that was 2 years ago and I still have my vision and it is good enough for me to function!
I think, too often, we physicians get too caught up in the treatment and get too worked up about end product or result. Often we forget the psychological aspects of what we do. I still hate going to the dentist – always afraid of the potential for pain.
The injections are a great treatment as you can tell. The ability to pro-actively help patients with macular degeneration was basically unheard of 15 years ago. The injections have changed what we do. Even treating diabetic retinopathy has become less frustrating!
As I have written before, the next generation of therapeutics will involve sustained release systems. These systems will be injected into the eye and will release their cargo for weeks or months; depending on design. Imagine a sustained release of Avastin!
All this to say that we will be “injecting” for a long time.
Thanks for commenting!
r
Hi, thanks for the excellent account. I have had 9 jabs: my doc. injects in the lower anterior quadrant i.e. I don’t see it coming, although I know it is.
A tip: I get the doc. to say just before he injects and I push my head back in the headrest a. far a. p. This is ‘cos once the jab hurt so much that I winced & jerked backwards. Best wishes, Ron (UK).
Thanks for commenting. Happy New Year.
Actually, there is are other reasons for choosing the “lower anterior quadrant.” Yes, we can be “sneaky,” but it gives us the most exposure (i.e. room to work with) and should there be any bleeding, gravity might keep the blood from obscuring the vision as it might settle in the bottom part of the eye. Last, when injecting steroids, such as Kenalog/Triamcinolone, the drug is injected as a suspension (white powdery mixture). The suspension will dissolve after several weeks, but may cause “floaters” until the drug dissolves.
Thanks again.
r
I am an 86 yr old lady who has had 2 Avastin shots in one eye in 2006. One before Cataract
surgery.. No Betadine used. Had a really bad eye infection after my second Cataract Surgery.
This lasted 5 weeks. I had very good sight for 4 years.
This summer I noticed that I had a dark
shadow in my left eye vision. I had another Doctor give me a shot of Avastin and he used
Betadine in and around my eye. I had a dark floater the first day but that went away. Then for
5 days my eye and surounding area was very sore. Still have a little distorted vision but hope
it gets better with time. I’m not looking forward to getting another shot too soon tho
Thelma
Thelma,
Thanks for sharing. Sounds like you are doing very well considering the usual severity of macular degeneration. I think the “floater” after the second shot was actually a tiny air bubble which absorbed within a day or so.
It also sounds as if you are very sensitive to Betadine. Ask your doctor, if you ever need another shot, if there are alternatives to Betadine. We use a diluted soap solution with patients sensitive to Betadine.
All the best. Stay well.
Randy
very interesting read…..except…mine did hurt. It’s really uncomfortable and my eye stung the next few days. Not sure why.
Dear Lisa,
Could be small scratch on the eye/cornea or sensitivity to the solutions before the injection (assuming they were used). Ask your doctor.
Randy