Eye injections

Why have I been advised eye injection?

Eye injections are used to control diseases that occur "inside" the eye. They are required as eye drops may not reach "inside"the eye to stop disease progression. After thoroughly examining your eyes, the best course of action with be suggested by your eye doctor. Usually, eye injections are suggested for these reasons:

• Abnormal growth of new blood vessels beneath the macula (CNVM): AMD, Myopia and injury

• Swelling of central retina (macular edema): Diabetes, vein occlusion, inflammation.

• In diabetics, when preparing the eye for retinal surgery

• Certain conditions that cause increased eye pressure

What are the eye injections available at present?

In general, eye injections are of two types - anti VEGF and steroid injections.

Anti-VEGF injections: The injection acts by reducing the swelling in the retina and by shrinking the new vessels. There are four types of injections commonly used in India at present – Eyelea (Drug: Aflibercept), Lucentis or Accentrix (Drug: Ranibizumab), Razumab (Drug: Biosimilar Ranibizumab) and Avastin (Drug: Bevacizumab).

Eyelea is a recent drug that probably works for a little longer than other drugs. Lucentis or Accentrix is the well recognised drug that has been approved and widely used for retina treatment. Avastin was not developed to treat eye conditions. It has been used as an “OFF-LABEL” drug to treat eye diseases with gratifying results.

Steroid injections: Steroids act by reducing the swelling in the retina. A small proportion of patients may develop increased eye pressure and cataract which may require additional treatment with eye drops and/or surgery. The commonly used injection is Ozurdex (Drug: Dexamethasone).

I am scared to take an eye injection. How are these injections given? Will the experience be painful and how long will it take?

People who have taken eye injections convey that the procedure itself is not very painful. It is like any other injection in the body. There are people who have taken multiple injections in both eyes are are quite comfortable with the process.

To prevent infections, eye injection is given in the operation theatre by following all protocols and precautions. Anaesthetic drops and cleansing solution (povidone iodine) are applied on the eye. The drug will be injected into the eye using a very thin needle. You will receive an eye bandage that has to be worn for two hours. After the bandage is removed, medications are started as per your eye doctor’s advice. The entire procedure in the operation theatre will take 5 - 10 minutes. Post injection you will be called after two days for re-examination and to check for side effects. The actual effects of injection will be known after 3-4 weeks.

My grandfather had many injections in both eyes. He says vision never improved. Why is that?

When taking eye injections, a few points have to be borne in mind. These are very important.

• Although some patients enjoy improved vision by taking eye injections, the goal of treatment is to PREVENT FURTHER LOSS OF VISION. If already lost, the ability to regain vision to see fine print and small objects is unpredictable. Visual outcome depends on severity of retinal damage and irreversible scars in the delicate retinal tissue prevent vision from improving.

• Since the goal is to PREVENT VISION LOSS, it has to be emphasised that early treatment before severe retinal damage sets in is very important to save good vision.

• There is no fixed number of injections. It is difficult to predict the number of injections that will be required in a particular eye. The need for injection is decided based on disease status and response of the eye to preceding injection. Therefore, correct follow up is necessary to decide the best course of action.

• There is a possibility of serious eye infection (endophthalmitis) or swelling with any eye injection. This rare complication may lead to severe permanent loss of vision/eye.