Intravitreal drug injection allows for the treatment of many retinal disorders including age-related macular degeneration, diabetic macular edema, and macular edema associated with vein occlusion, inflammation and other diseases. Medication is delivered by the physician under sterile conditions after applying anesthesia to (or "numbing") the eye. It is a relatively painless, routine procedure which has become an invaluable tool for treating many retinal disorders which can cause vision loss.
If a patient experiences severe pain, eyelid swelling, worsening vision, sensitivity to light, or thick discharge after an injection, the physician should be notified right away. Rarely an infection can occur after intravitreal injection. With prompt treatment there is no, or minimal, effect on vision, but without treatment the consequences can be severe.
These are some of the medications currently available for intravitreal use:
- Anti-VEGF medications for treatment of macular degeneration, diabetic macular edema, retinopathy of prematurity, edema from vein occlusions, and other causes of abnormal blood vessel growth and leakage. These medications work by inhibiting VEGF (vascular endothelial growth factor), a substance which causes abnormal growth of the blood vessels that can cause growth of scar tissue and leak fluid and blood causing significant and often permanent vision loss, if untreated. These medications include: bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (Eylea).
- Steroids for the treatment of macular edema caused by diabetic retinopathy, vein occlusion, post-surgical or inflammation in the eye. Steroids work by reducing inflammation and decreasing "leakage" from blood vessels, thereby reducing fluid accumulation (macular edema) in the retina. These medications include: triamcinolone acetonide (Kenalog, Triescence), dexamethasone and Ozurdex (dexamethasone intravitreal biodegradable implant).
- Antibacterial/antifungals/antiviral medications for the treatment of severe eye infections. A number of antibiotic medications are injected into the eye to treat specific infectious agents. This can quickly eradicate microbes by delivering a high concentration of medication directly into the eye, without side effects in other parts of the body.
- Vitreolysis for treatment of vitreomacular traction and macular holes. Ocriplasmin (Jetrea) is used to treat conditions caused when the vitreous pulls on the retina by releasing medically (using enzymatic cleavage) rather than surgically with vitrectomy. Although the success rate of relieving traction is only 40%, it may be worth considering in some patients because if it is successful surgery can be avoided.
