Intravitreal injection
What is Intravitreal injection? 
An intravitreal injection is a shot of medicine into the eye. The inside of the eye is filled with a jelly-like fluid (vitreous). During this procedure, doctors will inject medicine into the vitreous, near the retina at the back of the eye. The medicine can treat certain eye problems and help protect your vision. At the Japan International Eye Hospital, this method is most often used for the treatment of many retinal diseases. 
Common Intravitreal Medications
  • Antibiotic
  • Anti-inflammatory
  • Antiangiogenic drugs

Indications and contraindications to Intravitreal Injection

1. Indications

Intravitreal injection is indicated for patients with the following disease: 

  • Proliferative Diabetic Retinopathy
  •  Retinal neovasculariza
  • Diabetic macular edema
  • Macular Edema following Retinal Vein Occlusion
  • Neovascular glaucoma
  • Polypoidal choroidal vasculopathy
  • Age-related macular degeneration or Myopic macular degeneration
  • Central retinal vein occlusion
  • People with diseases of anterior uveitis, endophthalmitis, chorioretinitis
  • Persistent Posterior uveitis
  • Some other special diseases as prescribed by the doctor

2. Contraindications

  • Recent history of adverse thromboembolic events such as stroke
  • Patients have an acute infection of the eye (except in the case of endophthalmitis injection to treat endophthalmitis)
  • Patients with a history of allergy to the ingredients of the drug
  • Pregnant and breastfeeding women
  • Depending on the type of intravitreal medications, there will be specific contraindications
  • ·       Anti-inflammatory: contraindicated in patients with uncorrected intraocular pressure
  • ·       Anti-angiogenic: contraindicated in patients with a history of cardiovascular disease

Advantages and Disadvantages of Intravitreal injection

1. Advantages

  • Treatment with intraocular injections has demonstrated good effectiveness in the treatment of various retinal diseases especially in early-stage patients
  • Intravitreal injection is also easy to perform when there are factors that make it difficult for laser treatment such as corneal opacities, corneal scar, cataract, or vitreous hemorrhage.
  • Patients can have intravitreal injections and can go home the same day of the operation

2. Disadvantages 

  • With intravitreal injection treatment, patients often have to go through a long course of multiple injections for the treatment to be effective.
  • Although it’s rare, complications may occur. 

Intravitreal injection Procedure

Step 1: The eye is cleaned with an antiseptic solution

Step 2: Apply local anesthetic drops

Step 3: Place an eyelid holder

Step 4: Inject the drug into the anterior chamber or into the vitreous cavity

Step 5: Withdraw the needle, a sterile cotton swab can be used to prevent the drug from refluxing out.

The time for intraocular injection is only about 1 minute, but the patient needs to perform pre-injection preparation steps, so the whole process will take about 30 minutes.


What to expect after the injection? 

After injection, patients may experience some of the following eye symptoms:

1.  Non-dangerous symptoms: 

  • Mild irritation: will disappear after 1 hour 
  • Temporary blurred vision: vision before injection will regain in the following day
  • Subconjunctival hemorrhage: on the surface of the eye where the needle enters. This usually heals within 2-3 weeks 
  • Bubble in your vision: should resolve in 3-5 days 

2. Dangerous symptoms

Patients need to contact your retina specialist right away if they experience the following signs and symptoms of complications: 

  • Eye pain or discomfort that is not disappeared after 1-2 hours 
  • Significant decrease in vision 
  • Increased sensitivity to light
  • Increased floaters after the first day
  • Red eyes with discharge

Depending on the patient's condition and response to the medication, the medication may be effective after 1 week or longer. The treatment effect can only be maintained and reached the optimal level when the patients follow the treatment schedule. The schedule consists of multiple injections depending on the disease being treated. 

Do and Don’t 

1. Before injection 

  • Do not drive or operate machinery due to the effects of the anesthetic gel or drops that will be applied to the eyes on the day of injection 
  • Do not apply eye makeup on the day of injection
  • Do not drink alcohol on the day of injection 
  • If you are using contact lenses, please stop wearing them at least 3 days before the intravitreal injection.
  • Eat normally and continue using daily prescription medications if any.

2. After injection  

  • Using medicine as prescribed by doctors
  • You can shower on the day after the injection but please avoid washing your hair or getting any soap or water in the eyes. After 01 day, you can shower and clean your face normally.
  • You can apply foundation makeup after 01 day and eye make up after 3 days 
  • After injection, you can watch TV or read books normally, but pay attention to give the eyes a reasonable rest to avoid eye fatigue.
  • One day after injection, you can work normally with computers and phones, but please do not perform any heavy tasks.
  • The next day after injection, you can do some gentle exercises. Practice heavy exercises like gym, swimming, tennis, yoga, or running only after 3 days of injection. 
  • You can eat, drink and use the prescription medications as usual, but do limit alcohol consumption within 4 days from the day of injection.

Frequently Asked Questions about Intravitreal Injection 

1. Do Intravitreal Injection hurt?

Before giving an intravitreal injection, anesthetic eye drops are put in the eye to numb it. Therefore, most patients experience little or no pain with intravitreal injections

2. How long does it take to recover after the injection?

After the injection, when the effect of anesthetic eye drop wears off, you may feel a mild sensation. However, after few hours, your eye will feel normal again. 

3. How long is the follow-up time after the injection?

The doctor recommends that the patient should stay in the hospital for observation from 30 minutes to 1 hour, if there is no problem, patients can go home.

4. After injection, do I have to re-examine? 

To monitor and detect complications as soon as possible, the doctor will request the patient to re-examine 1 week after the injection. Your doctor will advise you to continue or stop using antibiotics after the injection at this follow-up examination. In addition, patients must follow the schedule of periodic re-examination when the next injections are carried out.  

5. How many injections will I need?

Depending on your disease and the drug being used the answer may be slightly different. Importantly, the treatment effect can only be maintained and reached the optimal level when the patient follows closely to the treatment schedule.

6. What are the risks of intravitreal Injection? 

  • Pain ( ration: 1 out of 20 ): This is just a temporarily symptoms 
  • External bleeding: Bleeding is minimal and the patient's eyes may be slightly red. This condition usually goes away on its own in 10-15 days
  • Internal bleeding: Heavy bleeding inside the vitreous (vitreous hemorrhage) during injection, possibly causing vision loss  (ratio: less than 1 in 1,000)
  • Increased intraocular pressure: This is just a temporarily symptoms 
  • Inflammatory eye conditions: can be treated with anti-inflammatory drugs
  • Retinal tear / detachment.
  • Cataract (from inadvertently hitting the lens)
  • Infection (endophthalmitis)

In some cases of severe bleeding in the vitreous, retinal detachment, or cataract, doctors will have to perform additional surgery and the patients will be required with special care to restore vision.

7. What will happen if the patient decides not to have the injection?

The patient's vision is likely to worsen. If the retina forms a scar or the eyes problem lasts too long, the patient may experience permanent vision loss in the affected eye.

8. Is there an alternative treatment to injections?

Laser treatment may be appropriate for the patient but is less effective than intravitreal injection

Intravitreal Injection at the Japan Eye International Hospital 

Intravitreal injection at the Japan International Eye Hospital is carried out by surgeons with many years of experience in retina & vitreous diseases. Our rigorous and thorough pre-operative intensive examination process, which meets the Japanese standards, enables us to have accurate diagnosis and treatment indications in time. We deliver a comprehensive care service, supporting you throughout your surgery. You can visit us for an examination or surgery alone. The convenient procedure, minimizing waiting time in all examination steps.