Intravitreal injections

Intravitreal injections are an important treatment method for treating serious retinal and macular diseases. The procedure involves injecting drugs directly into the vitreous of the eye, allowing the drug to act directly on the affected area. This treatment is widely used for diseases such as age-related macular degeneration, diabetic macular edema, and retinal vein occlusions.

1. Indications for Intravitreal Injections
Intravitreal injections are used to treat eye diseases that can lead to vision loss or severe vision impairment, such as:
– Age-related macular degeneration (AMD): Specifically the wet form of the disease, where abnormal vessels develop under the macula that may leak fluid or blood.
– Diabetic macular edema (DME): Caused by vascular damage to the retina due to diabetes, which leads to fluid accumulation in the macula.
– Retinal vein thrombosis: This condition leads to reduced blood flow and fluid leakage into the retina.

2. Drug Categories Used in Intravenous Infusions

The drugs used in intravitreal injections fall into two main categories: anti-angiogenics (anti-VEGF) and corticosteroids.

a. Anti-Angiogenic (Anti-VEGF)
Anti-angiogenic drugs prevent the growth of abnormal blood vessels in the retina and macula, which can help stabilize or even improve vision in various conditions.

• Ranibizumab: One of the first anti-angiogenic drugs approved for use in intravitreal injections. It is widely used in the treatment of age-related macular degeneration and diabetic edema.
• Bevacizumab: It is used off-label to treat similar conditions and has comparable efficacy to ranibizumab.
• Aflibercept: Targets the VEGF-A factor, which promotes angiogenesis, and is widely used in cases of resistant age-related degeneration and diabetic edema.
• Brolucizumab: This is a new anti-VEGF that offers a longer duration of action, resulting in fewer repeat infusions.
• Faricimab: This is a new anti-VEGF that offers a longer duration of action, resulting in fewer repeat infusions.

b. Corticosteroids
Corticosteroids are used to reduce inflammation and vascular permeability, combating swelling in the macula.

• Dexamethasone: Used as an implant that releases the drug gradually over a prolonged period. It is effective in cases of diabetic edema and retinal thrombosis.
• Fluocinolone acetonide: Another implant that releases the drug over an even longer period of time, often for several months. It is suitable for chronic conditions.

3. The Intraocular Injection Procedure
The injection is performed under conditions that meet the highest standards of aseptic technique to prevent infection. The ophthalmologist anesthetizes the eye and applies antiseptics. The injection is performed at a specific point on the eyeball with careful guidance, and the entire procedure takes only a few minutes. Patients can return home immediately, although they are usually advised to avoid strenuous activities for one to two days.

4. Risks and Complications
The most common complications are mild discomfort or redness of the eye after the injection. However, there are also rare but serious risks, such as:
– Infection (endophthalmitis): Although rare, it is one of the most serious complications.
– Retinal detachment: Usually caused by injury during the injection.
– Bleeding and increased intraocular pressure: Possible immediate complications that require medical attention.

 
Intravitreal injections are an effective and safe way to treat serious macular and retinal diseases. By applying anti-angiogenic drugs and corticosteroids, this treatment helps to preserve and improve vision, while allowing patients to live with a better quality of life.