Intravitreal injection – IVT
Intravitreal injections have revolutionized the management of macular diseases. They are performed under sterile conditions, with local anesthesia administered via eye drops. Virtually painless, these injections allow for the treatment of wet age-related macular degeneration (AMD), macular edema related to diabetes or post- venous occlusion , as well as neovascularization in highly myopic patients.
What is an intravitreal injection (IVT)?
Intravitreal injections allow a pharmacological agent (medicine) to be deposited directly into the vitreous body, as close as possible to the retina.
The injections are performed in the office (no hospitalization, no fasting), under local anesthesia. Sterility conditions must be respected: wearing gloves and disinfecting the face.
They allow the treatment of macular edema and neovascularization related to AMD, diabetes, venous occlusions or high myopia.
What medications are injected?
The active ingredients injected into the eye during intravitreal injections belong to two main therapeutic classes:
Anti-VEGF (vascular epithelial growth factor) drugs are used to treat neovascularization, that is, abnormal blood vessels developing on the retina or macula. The products available on the market are: Ranibizumab (Lucentis®), Aflibercept (Eylea®), and Bevacizumab (Avastin®).
Corticosteroids are used to treat eye inflammation that causes edema or other complications. They are available as microscopic, long-acting implants. The available products are the dexamethazone implant (Ozurdex®) and the fluorometholone implant (Iluvien®).
What pathologies are treated by IVT?
Intravitreal injections allow the treatment of macular edema, retinal neovascularization, and ocular inflammation. The treatable conditions are therefore, in order of frequency:
Venous occlusions (CRVO, BRVO,…)
The neovascularization of the highly myopic
Posterior uveitis
The polyps
Retinopathy of Prematurity
Sickle cell retinopathy
What type of anesthesia is needed for an injection?
Intravitreal injections are performed under topical anesthesia using Oxybuprocaine® or Tetracaine® drops.
These have an almost immediate effect, allowing any pain to be relieved during the procedure.
Procedure for an IVT
Intravitreal injections are performed in the doctor's office or in a healthcare facility (clinic or hospital). This is a quick intraocular procedure that does not require consultation with an anesthesiologist, fasting, or hospitalization. However, it is carried out in an operating room under sterile conditions.
The injection steps are:
Eye preparation in the waiting room: local anesthesia with Oxybuprocaine drops.
Hygiene & protection measures: wearing a hairnet +/- a tunic.
Entry into the injection room and placement on the injection chair in a reclining position.
Disinfect the skin and conjunctiva with Betadine ophthalmic® twice.
Face protection with a sterile, perforated drape.
Placement of a blepharostat (eyelid retractor).
Look down and in the opposite direction from the treated side.
The injection is performed by the ophthalmologist (2 to 5 seconds of treatment).
Rinse the eye thoroughly with saline solution.
Removal of the blepharostat.
At the end of the procedure, sit down calmly and check that you are not dizzy. Once you are fully upright, you can return to the waiting room to change.
Post-injection care and recovery
After the injection, the eye is irritated by the betadine. The prescribed treatments are intended to relieve these symptoms:
Rinse the eye thoroughly with saline solution 2 to 6 times a day.
Abundant hydration using artificial tears such as Vismed®, Théalose® or Artelac®.
Role of antibiotics after an IV injection
Post-intravitreal injection antibiotic prophylaxis has long been recommended. However, the most recent meta-analyses contradict this practice, as antibiotic prophylaxis does not decrease the risk of infection but increases the selection of resistant bacteria.
Adverse effects and complications of intravitreal injections
It is necessary to distinguish between the side effects, which are frequent, unpleasant but not serious after injections, and complications, which are extremely rare but can affect the visual prognosis.
Side effects
Transient decrease in vision.
Myodesopsia – Vision of the product in the vitreous body: floaters, swirls or rods.
Eye irritation – Sensation of dryness and watering.
Subconjunctival hemorrhage – Blood spot at the injection site.
Traumatic cataract – The needle touches the lens capsule.
Retinal detachment – A tear forms on the retina at the site of the injection.
Acute glaucoma – The injection of the product causes a spike in intraocular pressure.
Endophthalmitis – A serious intraocular infection occurring 3 to 6 days after injection.
Do intravitreal injections hurt?
No. An intravitreal injection is never pleasant, but only exceptionally painful. The procedure lasts a few seconds and can be startling, but it is made bearable by local anesthetics.
How effective is an intravitreal injection?
Intravitreal injections are effective for 4 to 12 weeks, depending on the patient and the severity of the disease. This means they will need to be repeated regularly, according to the frequency of relapses of your chronic condition.
In short, the injections are usually administered regularly and for life. The average interval between injections is 6 to 8 weeks.
What are the side effects of intravitreal injections?
Intravitreal injections are often irritating and unpleasant. Side effects are common but not serious. These should be distinguished from complications, which are rare but serious. The main side effects are:
Irritation – Caused by Betadine – Leading to redness, tearing, discomfort.
Subconjunctival hemorrhage – Bleeding on the surface of the eye.
Myodesopsia – Floaters.
What are the complications of intravitreal injections?
Complications are rare and unpredictable events. They can leave serious ocular sequelae, even leading to the loss of the eye. Potential complications during intravitreal injection (IVT) include:
Traumatic cataract
Retinal detachment
Vitreous hemorrhage
Endophthalmitis
Acute glaucoma
What is the price of an intravitreal injection?
Intravitreal injections are reimbursed by social security at a rate of €83.60 (sector 1). An additional fee may be charged by the ophthalmologist (sector 2).
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