All about Intravitreal Anti-VEGF treatment - Indications, Procedure, Side-effects and Risks
What is Intravitreal Anti-VEGF treatment? How do Anti-Vascular Endothelial Growth Factor injections prevent sight loss in patients with retinal conditions?
Patients with certain retinal conditions can lose central vision due to the growth of abnormal blood vessels which then bleed or leak fluid under the retina at the back of the eye. Anti–Vascular Endothelial Growth Factor therapy, also known as Anti-VEGF therapy, is the use of medications to block vascular endothelial growth factor which stops the abnormal blood vessels from growing and leaking or bleeding under the retina. This prevents or limits damage to the retinal light receptors. These medicines are effective in preventing further central vision loss in up to 90% of treated eyes. Typically, treatment involves a series of injections of anti-VEGF medicines given into the back of the eye.
What eye diseases or conditions are treated with Anti-VEGF injections?
Anti-VEGF treatment is recommended in the following retinal conditions of the eye:
Diabetic Macular Edema (DME)
Retinal Vein Occlusion (RVO)
Myopic Choroidal Neovascularization (CNVM)
Any other retinal condition that causes fluid to leak under the retina
How does the Ophthalmologist come to a diagnosis and decision of injecting Anti-VEGF drug?
After clinically examining the retina, your treating ophthalmologist will perform some diagnostic scans like Fundus photos and OCT (Optical Coherence Tomography) and show the different layers of the retina and whether there is blood or fluid present within the retinal layers. After evaluating the test reports, the ophthalmologist will tell you whether you will benefit from anti-VEGF therapy - only patients with active leaking of blood and fluid can benefit from it. Appropriate treatment plan will be discussed with you as to which anti-VEGF medicine will be the best and how many injections might be needed. Many patients require a loading course of three injections at regular intervals of four weeks. After the first three courses of injections, few patients will require further injections, depending on the leakiness of the blood vessels. You will need to be reviewed at regular intervals (timing to be decided at each visit), as to when further treatment might be given. This will ensure benefits of the treatment are maintained.
How is the procedure of intravitreal Anti-VEGF injection performed?
The procedure is best done in the operation theatre with all aseptic precautions. The drug is injected into your eye with a fine needle. Only minimal discomfort is to be expected (equivalent to having blood taken from your arm). The whole procedure takes around 10 minutes, but the injection itself is over in less than 20 seconds.
The injection is given with you lying down comfortably. First, local anaesthetic drops are applied to numb your eye and minimise discomfort. Then, your eyelids and surface of the eye are cleaned to prevent infection. Your face and the area around your eye will be covered by a small surgical sheet (a drape) to keep the area sterile. A small clip (speculum) will be used to keep the eye open. The injection site is marked with callipers and your eye is stabilised with forceps or a cotton bud. A few seconds later, the injection is given.
After the injection, antibiotic and lubricating eyedrops are prescribed. Your next appointment will be scheduled for the next day. It is important to check the intraocular pressure on the next day.
What precautions should I take after getting the Anti-VEGF injection?
There are no special precautions following intravitreal injections but please avoid getting water into your eye or swimming for the first few days afterwards.
Krishna Netralaya's team of specialist Ophthalmologists bring together years of experience of treating retinal conditions with Anti-VEGF therapy
Who should not be treated with Anti-VEGF or needs special caution?
Anti-VEGF treatment may not be recommended for people in the following categories:
Pregnant or breast-feeding women - If you are pregnant or planning to become pregnant, please discuss this with your doctor before your intravitreal injection treatment. Anti-VEGF medicines should be used with caution during pregnancy. Women of child-bearing potential should use effective contraception during their treatment and for at least three months after the last intravitreal injection. If you do become pregnant whilst undergoing intravitreal injections, please inform your doctor immediately. Anti-VEGF medicines are not recommended during breastfeeding because it is not known whether the medicine passes into human milk. Ask your doctor for advice before treatment.
People who have an infection in or around either eye or severe infection anywhere in their body should not be given anti-VEGF therapy.
Anti-VEGF should be used with caution in patients who have had a heart attack or stroke in the last three months, or who have uncontrolled angina or uncontrolled high blood pressure. Please ensure you inform the doctor if there are any changes in your medical condition.
People with an allergy to anti-VEGF medication should not be given anti-VEGF therapy.
What are the risks associated with Anti-VEGF injections?
As with any medical procedure, there is a small risk of complications following anti-VEGF treatment. Most complications that might occur are from the injection itself, rather than the drug. For most patients, the benefit of the treatment outweighs the small risk of injection injury. The following are some of the common side effects and major potential risks of anti-VEGF injections. It is important to note that these risks are all rare and significant loss of vision due to this treatment is very uncommon.
Some common side effects of Anti-VEGF injections
Discomfort and redness for the first few days after your treatment (there is usually a bleed or bruise on the white part of the eye at the site of injection, which clears in a week or two)
Sore and gritty eye
‘Blobs’ or ‘small specks’ in your vision (‘floaters’) might be seen for a few days after the injection
You may also experience transient flashing lights or swirls of light immediately after the injection. It is important to note that most of the discomfort relating to injections is due to the use of Povidone Iodine antiseptic. This is a vital part of the injection process and reduces the risk of infection.
If your eye becomes redder, sensitive to light, swollen and painful, or your vision gets worse after the anti-VEGF treatment, you must inform your ophthalmologist at once. This might be a sign of infection, which would normally occur within the first week after the injection, with minimal risk.
Some rare risks of Anti-VEGF injections
Serious eye infection (one in 2,000 cases)
Increased intra-ocular pressure in the eye
Blood clots and bleeding in the eye
Inflammation inside the eye
Can other medicines or food affect Anti-VEGF treatments?
Anti-VEGF and certain other medicines can interact with each other. Some patients have developed a serious eye inflammation when receiving treatment with both anti-VEGF and Verteporfin (Visudynephotodynamic therapy or PDT). To avoid this, tell your eye doctor about all the medicines you take, whether prescription or non-prescription medicines. This includes blood pressure medication, warfarin, aspirin, and vitamins. You must also inform the doctor if any medication has changed since your last visit.
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Disclaimer: All information, provided above is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.