Intravitreal injection of anti-VEGF

Background

An intravitreal injection (an injection into the vitreous of the eye) is a way to deliver a medicine directly to where it is needed. In conditions such as age related macular degeneration, vein occlusions, diabetes and short sightedness, a medicine called an Anti-Vascular Endothelial.

Growth factor (anti-VEGF) agent can be used. These drugs stop a protein (VEGF), which is produced by cells in the retina, from working. This works by limiting the growth and leakage of abnormal blood vessels in the innermost layers of the eye.

The aim of this treatment is to help prevent worsening vision.

Before your procedure

Take your routine medications as normal. You can eat and drink before and after the procedure as normal.

Please inform the medical team if you are pregnant or breast feeding, recently been treated for an infection or on antibiotics for any infections, have had a recent myocardial infarction (heart attack), cerebrovascular accident (stroke) or inpatient hospital attendance, as this may affect the scheduling of your injection appointment.

The procedure

How is anti-VEGF given?

Anti-VEGF is given as an injection into the vitreous (the jelly-like substance inside the eye). Before the procedure dilating drops will be administered. The procedure takes around 15 minutes, although the injection only takes a few seconds and causes minimal discomfort.

This procedure is performed in an operating theatre or a ‘clean room’.

After getting into a comfortable and reclined position, drops will be given to make the eye go numb. The area around the eye will then be cleaned and a small spring used (speculum) to keep your eye open so you do not have to worry about blinking. The medicine is then injected using a fine needle and some lubricating drops applied for comfort.

After the procedure

Leaving hospital

Many patients find it easier to be accompanied by a friend or relative because the drops used blur the vision for a short while afterwards.

Generally, most people who have had this procedure will be able to leave hospital within one hour. However, we might ask you to wait to have your eye pressure checked.

Resuming normal activities including work, driving and operating machinery

Usually you can resume normal activities the following day.

Special measures after the procedure

• Avoid rubbing the eye.
• You will be given lubricating eye drops or ointment to use three times a day for three days; however, they can be used more frequently to help alleviate any discomfort during the first few days.
• You can also take your normal painkillers to alleviate any discomfort during the first few days.

Check-ups and results

Your next appointment will be scheduled before you go home or sent to you by post. Most patients require an initial course of three injections at monthly intervals. Patients need to be reviewed at regular intervals thereafter for continued monitoring and to assess the need for further courses of medication.

If your follow up appointment is delayed please contact the co-ordinator on 01223 254662 leave a voice message if prompted.

Risks of having intravitreal injections

As with any medical procedure, there is a small risk of complications following intravitreal treatment. Most of the potential complications result from the injection procedure itself rather than the drug.

For most patients, the benefit of treatment with anti-VEGF greatly outweighs the risks which are involved. Significant loss of vision due to this treatment is very uncommon.

Common risks

• A sub-conjunctival haemorrhage (bloodshot eye) can occur, but it does not affect vision. This will gradually fade within seven to ten days.
• Your vision may be more blurred for several hours after this treatment.
• It is quite common to notice some 'floaters' in your vision, these fade over a few days.
• You might experience a sharp discomfort on the day of the injection. This discomfort should be relieved by normal painkillers and the use of lubricating eye ointment.
• In some cases you might experience a sharp, painful, watery eye on the day of the injection. It is important that you use the lubricating eye ointment on a regular basis, normal painkillers should relieve some of the pain. The pain should subside by the end of the following day. Increasing pain the day after or new pain that is worsening is not typical.

Rare risks

• Inflammation inside the eye (uveitis).
• Increased eye pressure (intraocular hypertension).
• Bleeding inside the eye (vitreous haemorrhage).
• Detachment of the retina (retinal detachment).
• Formation of lens opacity (cataract).

There is a very small risk (1:2000) of developing an infection in the eye (endophthalmitis) following an intravitreal injection.

The warning symptoms of this complication are rapid onset of:

• Increasing eye pain the day after the injection, up to a week later.
• Increasing redness of the eye.
• Greatly decreased vision.

You must contact the hospital immediately for advice if you develop these warning symptoms. It is very important to identify and treat this type of infection as quickly as possible.

There are some other side effects not related to the eye which include high blood pressure and headache. There is a theoretical increased risk of stroke with anti-VEGF drugs.

Alternative treatments

There are many clinical trials being undertaken to investigate treatment for conditions of the macula. Currently there is no alternative way of administering anti-VEGF medications into the eye.

There are some situations when combinations of treatments may be needed. Your ophthalmologists will discuss these options with you in your consultation if required.

What can I do to help myself?

• Stop smoking.
• Maintain a healthy balanced lifestyle.
• Protect your eyes against the sun.
• Attend your eye clinic appointments and check-ups.

The organisations below can provide more information and support for you. Please note that Addenbrooke’s Hospital is not responsible for the quality or accuracy of any information or advice provided by these organisations:

• Macular Society

Crown Chambers, South St, Andover, Hampshire SP10 2BN
Helpline: 0300 3030 111
Email Macular Society help
General enquiries: 01264 350551
Email the Macular Society (general enquiries)
Macular Society website (opens in a new tab)

• Diabetic Retinopathy Organisation

Dr David Kinshuck, Good Hope Diabetic Clinic
Diabetic Retinopathy Organisation website (opens in a new tab)

• National Institute for Health and Care Excellence

MidCity Place, 71 High Holborn, London, WC1V 6NA
Tel: 0845 003 7780
National Institute for Health and Care Excellence website (opens in a new tab)

• The Royal College of Ophthalmologists

17 Cornwall Terrace, London, NW1 4QW
Tel: 020 7935 0702
The Royal College of Ophthalmologists website (opens in a new tab)

• Royal National Institute of Blind People

105 Judd Street, London, WC1H 9NE
Tel: 0303 123 9999
Royal National Institute of Blind People website (opens in a new tab)

Emergency contact telephone number

Emergency Eye Clinic
Monday to Friday 08:30 (8:30am) to 16:00 (4pm) 01223 217778
(Leave a message with your name, date of birth and hospital number, and a brief description of your concern, and one of the nurses will call you back.)

Out-of-hours Main Hospital Switchboard 01223 245151 and ask for the on-call ophthalmologist

Additional ophthalmology contact telephone numbers

• Clinic coordinator 01223 254662
• Medical retina specialist nurse 01223 256672
• Eye Clinic liaison officer 01223 216577
• Clinic 14 reception desk 01223 216401