Anthony V. Spiteri
Intra-vitreal Injections

Intra-vitreal Injections

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. It is caused by the breakdown of the central portion of the retina called the macula. This is the nerve layer part of your eye that works like the film in a camera to pick up the picture. 

The macula is responsible for the fine central vision in the eye that is needed for driving a car, reading fine print, recognizing faces, etc. There are two types of macular degeneration: dry and wet. In the “wet” form of AMD, abnormal blood vessels grow in the back of the eye. Sometimes these vessels leak blood or fluid that causes blurred or distorted vision. Without treatment, vision loss may be quick and severe.

There are other eye conditions that cause loss of vision due to abnormal growth of blood vessels in the back of the eye. These can occur even in young patients, and include, but are not limited to, conditions such as high myopia (short-sightedness), and eye injury. Sometimes there is no known reason for the abnormal blood vessels. Without treatment, vision loss may be quick and severe.

Refractory macular oedema, or swelling around the macula, is oedema that affects vision but does not respond adequately to the usual treatment methods. It can occur with conditions such as central retinal vein occlusion and diabetic retinopathy. Without effective treatment, vision loss may progress and become permanent.

POSSIBLE BENEFITS AND “OFF-LICENCE” STATUS:

Avastin was not initially developed to treat your eye condition. Based upon the results of clinical trials that demonstrated its safety and effectiveness, Once a device or medication is licensed by the government, physicians may use it “off-licence” for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using Avastin “off-licence” to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin had less fluid and more normal-appearing maculas, and their vision improved. Avastin is also used, therefore, to treat macular oedema, or swelling of the macula.

POSSIBLE LIMITATIONS AND ADMINISTRATION:

The goal of treatment is to prevent further loss of vision. Although some patients have regained vision, the medication may not restore vision that has already been lost, and may not ultimately prevent further loss of vision caused by the disease. After the pupil is dilated and the eye is numbed with anaesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. Avastin is administered by an injection into your eye as needed at regular intervals (about every six to eight weeks); your ophthalmologist will tell you how often you will receive the injection, and for how long. The majority of people with wet AMD need a number of – or even continuous treatments.

ALTERNATIVES:

You do not have to receive treatment for your condition, although without treatment, these diseases usually cause further vision loss, sometimes very quickly. Other forms of treatment are available. At present, approved treatments for neovascular age-related macular degeneration include injection into the eye of drugs called Eyelea or Lucentis. These treatments are available through Jersey Health and Social Services.  Here, in Jersey the first type of Anti-vegf used for the majority of patients is Avastin .Your doctor will discuss with you the benefits and risks associated with these various treatments. In addition to the approved medications, some ophthalmologists use intravitreal Kenalog - a long-acting cortisone-like drug - “off-licence” to treat eye conditions like yours.

POSSIBLE COMPLICATIONS FROM THE MEDICATION AND INJECTION:

Complications when Avastin is given to patients with cancer:

When Avastin is given to patients with bowel cancer, some patients experienced serious and sometimes life-threatening complications, such as gastrointestinal perforations or wound healing complications, haemorrhage, arterial thrombo-embolic events (such as stroke or heart attack), hypertension, urinary problems, and congestive heart failure. Patients who experienced these complications not only had bowel cancer, but were also given 400 times the dose you will be given, at more frequent intervals, and in a way (through an intravenous infusion) that spread the drug throughout their bodies. 


The risk when Avastin is given to treat patients with eye conditions: 

Ophthalmologists believe that the risk of these complications for patients with eye conditions is low. Patients receiving Avastin for eye conditions are healthier than the cancer patients, and receive a much smaller dose, delivered only into the cavity of their eye. While there are no approved studies about the use of Avastin in the eye that prove it is safe and effective, there are ongoing clinical trials of a similar drug as well as studies of patients receiving Avastin “off-licence.” One study of patients who received Avastin through an intravenous infusion reported only a mild elevation in blood pressure. Another study of patients treated like you will be with intravitreal Avastin (that is, Avastin injected into the eye) did not have these elevations or the other serious problems seen in the patients with cancer. However, the benefits and risks of intravitreal Avastin for eye conditions are not yet fully known. In addition, whenever a medication is used in a large number of patients, a small number of coincidental life-threatening problems may occur that have no relationship to the treatment. For example, patients with diabetes are already at increased risk for heart attacks and strokes. If one of these patients being treated with Avastin suffers a heart attack or stroke, it may be caused by the diabetes and not the Avastin treatment. 

Known risks of intravitreal eye injections: 

Your condition may not get better or may become worse. Any or all of these complications may cause decreased vision and/or have a possibility of causing further loss of vision. Additional procedures may be needed to treat these complications. During the follow up visits  you will be checked for possible side effects and the results will be discussed with you. Any medication has the potential to cause allergic reactions in a small number of people. Symptoms of an allergic reaction can include a rash, hives, itching and shortness of breath. In general, allergic reactions to medicines are more likely to occur in people who have allergies to other drugs or foods, or things in the environment, such as dust or grass. If you have allergies to other medicines, foods, or other things in the environment, or if you have asthma, you should let your doctor know.

Possible complications and side effects of the procedure and administration of Avastin include but are not limited to:

  • Retinal detachment, 
  • Cataract formation (clouding of the lens of the eye)
  • Glaucoma (increased pressure in the eye)
  • Hypotony (reduced pressure in the eye)
  • Damage to the retina or cornea (structures of the eye), and bleeding. 
  • There is also the possibility of an eye infection (endophthalmitis). You may receive eye drops with instructions on when to use them to reduce the possibility of this occurring.

 Any of these rare complications may lead to severe, permanent loss of vision. Patients receiving an injection of Avastin may experience less severe side effects related to the pre-injection preparation procedure (eyelid speculum, anaesthetic drops, dilating drops, antibiotic drops or povidone-iodine drops). These side effects may include eye pain, subconjunctival haemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the cornea, inflammation of the eye, and visual disturbances.

PATIENT RESPONSIBILITIES:

The patient should immediately contact the Eye Clinic if any of the following signs of infection or other complications develop: 

  • Pain
  • Blurry or decreased vision
  • Sensitivity to light, redness of the eye (compared to immediately after the injection)
  • Discharge from the eye. 
  • DO NOT to rub your eyes or swim for three days after each injection. Keep all post-injection appointments so the doctor can check for complications. 

Though the likelihood of serious complications affecting other organs of the body is low, the patient should contact their GP or go to the Accident and Emergency Dept if they experience abdominal pain associated with constipation and vomiting, abnormal bleeding, chest pain, severe headache, slurred speech, or weakness on one side of the body.  The patient should also notify their ophthalmologist of these problems. 

The patient should inform the ophthalmologist if they need to have any surgery, and inform any other surgeon, including dentists, that they are on a medication that needs to be stopped before surgery. 

Contact Us


form1

Anthony V. Spiteri, News

Halloween goers warned of dangers of costume contact lenses:
02/10/2020

Halloween goers are being warned not to use costume contact lenses, unless they are bought from a professional.
Current Trends and Acceptance of Bilateral Same-day Surgery:
12/10/2016

Bilateral same-day cataract surgery has become a topic of controversy over the past several years, particularly with the increased focus on refractive procedures such as clear lens extraction and phakic intraocular lenses (IOLs).

LITTLE GROVE CLINIC
LA RUE DE HAUT
ST LAWRENCE
JERSEY
JE3 1JZ