• You may need an intravitreal injection if you suffer from any of the following:
• Vitroretinal traction
• Age-related macular degeneration of the exudative type (wet form)
• Clinically significant macular edema or productive diabetic retinopathy (conditions caused by uncontrolled diabetes mellitus)
• Endophthalmitis (infection inside the eye)
• Uveitis (inflammation of the eye)
• Cystic macular edema of various etiologies (e.g. retinal vein occlusion)

The injection is performed under relatively sterile conditions, i.e. a sterile eye isolation field, sterile gloves and instruments are used. However, according to international guidelines, the use of a surgical area is not required, but can be performed in a dedicated room. It is performed under local anesthesia with tetracaine or alkaine drops after the peri-ocular area has been cleaned with Betadine and diluted Betadine has been instilled into the eye. An experienced ophthalmologist completes the entire procedure in just a few minutes. The patient does not feel any pain.

After the injection, tap water or seawater should not be allowed to enter the eye for 2-3 days. Antibiotic drops are not required, as international studies have not shown that they protect against the possibility of infection, except in cases where there is a risk factor in the eye such as blepharitis. If you experience severe pain or any changes in your vision (blurring, decreased vision) in the first few days after the injection, you should inform your ophthalmologist. Depending on the drug used in the injection, a specific monitoring and re-examination protocol is followed, which your doctor will inform you about.

In macular diseases, which is the most common indication for intravitreal injections, antiangiogenic agents (anti-VEGF, vascular endothelial growth factor inhibitors) are most commonly injected. Antiangiogenic agents cover a wide range of macular diseases, such as exudative macular degeneration (wet form) of age-related etiology, as well as vascular diseases of the macula, such as diabetic macular edema and macular edema after retinal vein occlusion or its branch. The approved pharmaceutical antiangiogenic agents currently used are Ranibizumab (LUCENTIS) and Aflibercept (EYLEA). While there are many studies on various new drugs that will be added to the quiver of ophthalmologists in the near future. Recently, a slow-release cortisone-dexamethasone preparation (OZURDEX) was approved for macular edema in vascular diseases, which is implanted intravitreously and has an effect for 6 months.

Other drugs used for intravitreal injection are some immunosuppressive agents (e.g. Methotrexate) aimed at treating uveitis or antibiotics in cases of endophthalmitis. Finally, the drug ocriplasmin (JETREA) helps in the resolution of vitreo-macular traction, which is caused by vitreo-macular adhesion in which the vitreous body of the eye exhibits abnormally strong adhesion to the central part of the retina (the light-sensitive membrane at the back of the eye). Its effectiveness is impressive when the right selection of cases is made.

Fortunately, the risk of serious vision-threatening complications is extremely low when the injection is performed by an experienced ophthalmologist and the procedures are followed as they should be. Usually after the injection you will have a foreign body sensation in the eye for the first day, which may begin when the anesthetic drops have worn off. Sometimes a small superficial hemorrhage may occur at the point where the needle entered the eye, which is absorbed within a few days. Some patients complain of seeing something swimming in their eye, this is either the medication that has been injected intravitreally or a small air bubble that was introduced into the eye with the injection and will gradually be absorbed. Despite the fact that the correct procedure is followed, complications such as endophthalmitis (infection of the inside of the eye), the incidence of which is 0.2% for each injection, retinal detachment (the risk of which is reduced by very fine needles), the incidence of which is 0.9% per injection, can occur very rarely. Transient ocular hypertension is more likely than a long-term increase in intraocular pressure, which could lead to glaucoma. In eyes with normal intraocular pressure, the transient increase in intraocular pressure after the injection usually returns to normal levels without any intervention. Intravitreal cortisone injection is not contraindicated even in patients with glaucoma, with the only difference being that more intensive monitoring is needed. Traumatic cataract formation is a rare acute complication of intravitreal injection in the event of injury to the crystalline lens of the eye. However, in repeated intravitreal injections, the rate of progression of nuclear or cortical cataract is increased. Also rare is aseptic inflammation (aseptic endophthalmitis), which is an immune reaction of the body. All complications, no matter how rare, must be treated immediately so that the eye and vision are not endangered. Therefore, it is essential to report any discomfort or symptom you have to your doctor.