The Precivia, IVT injection device
The Precivia (IVT injection device)

An Intravitreal injection a procedure for AMD

Intravitreal Injection

An Intravitreal injection a procedure for AMD

Age-Related Macular degeneration is an extremely common eye disease usually affecting individuals aged 50 years and over. AMD can come in either wet or dry form, and your treatment will differ depending on this. AMD affects vision and is experienced as a loss of central vision, distorted central vision/wavy lines or a dark shadow appearing. The cause of the deterioration is growth of abnormal blood vessels in the back of the eye (retina) which are prone to leaking. To help stabilise or slow the effects of this overgrowth/leakage, repeated intravitreal injections can be administered until stabilisation is seen.

An Intravitreal injection is a procedure where medication (anti VEGF) is injected into the eye into the vitreous. This procedure is used to treat Wet Age-Related Macular Degeneration (AMD). The injection is given at 3.5/4mm from the limbus through the sclera (white of the eye).
The drugs administered are known as anti-VEGF agents – Ranibizumab (Lucentis), Afibercept (Eyelea) and Bevacizumab (Avastin).

Eye Clinic Procedure or Specialist Treatment Centre

Outpatient Procedure

Intravitreal injections are routinely performed as an outpatient procedure under local anaesthetic, either in an Eye Clinic Procedure Room or Specialist Treatment Centre. Your treatment will be mapped out by an Ophthalmic Medical Retina Consultant, who will organise for the clinic to notify you of your treatment plan and book all appointments for you. The injections may be administered by a doctor or a nurse practitioner, please note different techniques may be used by different injectors. Whilst clinics always aim to run on time, you may experience some delays and be required to be in the department for two hours.

Once you have arrived at the department, you will be checked in at reception and asked to sit in a waiting area. Once the team are ready for you, they will call you through to the treatment room. You begin by having local anaesthetic drops to numb the eye. This will then be followed by the clinician cleaning the area using iodine based antiseptic solution, paying extra attention to the eyelashes as this is known to be an area for bacteria build up. The clinician will then administer more eye drops to ensure the eye is completely numb and clean to reduce the risk of infection. Dependant on the technique used by the injector, they may then use a surgical drape to cover your face and eye area to maintain a sterile field. A wire speculum (clip) may then be used to keep the eye open during the procedure. You will be told in which direction to look as they use a caliper to mark the site of the injection and as the drug is injected it is important to keep your eye as still as you can.

reduces the risk of human error

The Precivia (IVT injection device)

An alternative technique to the above freehand method, is when an intravitreal injection device is used. The Precivia (IVT injection device) will measure the angle, depth and placement of the injection for you, whilst eliminating the speculum, caliper and drape listed above. The device reduces the risk of human error and has been found to be preferable for patients. Several studies have found the Precivia to be financially beneficial and also can significantly reduce treatment time.

Intravitreal injections should not be painful, topical anaesthetic drops are used to numb the eye to ensure patient comfort. A slight pressure sensation may be experiences when the needles is entering the eye, similar to that of a blood test. Any discomfort experiences can depend on various factors as some individuals may be more sensitive than others. The speculum that holds the eye open can cause a sensation of pressure and discomfort for some patients, that is why an injection device has been reported to be preferential for many patients.
As with any medical or surgical procedure there is a small risk of complications following intravitreal injections. For most patients the benefit of the treatment outweighs the risks.

Including serious but rare complications include

There are some common side effects

Common side effects include:
• Pain or an ache in the eye, please take over the counter pain medication as necessary.
• Sore and gritty eye.
• Red or blood shot eye. This can look dramatic but is nothing to worry about.
• Corneal scratch.
• Floaters, shadows, bubbles, dots that may last a couple of days.

Serious but rare complications include:
• Raised eye pressure.
• Inflammation.
• Cataract.
• Retinal detachment.
• Haemorrhage (bleeding inside in the eye).
• Severe infection (endophthalmitis).
• Loss of vision.

Summary
• The aim of the intravitreal therapy is to stabilise or improve your vision.
• The outcome depends largely upon your individual eye condition.
• Your eye condition may not improve or it may become worse despite these injections.
• Injections into the eye are generally safe procedures.
• Side effects may happen and some may be serious. Additional procedures may be needed to treat these complications.
• Each injection carries similar risks of developing any of the side effects or complications described.