While this "scope of practice" debate continues on, ophthalmology residency programs are now training their residents to properly perform IVIs as part of a comprehensive curriculum. Given the risk of complications, especially endophthalmitis and suprachoroidal hemorrhage, and the need to handle these complications, IVI by generalists is controversial and even opposed by some vitreoretinal specialists. This procedure, considered a subspecialty skill, is increasingly performed in the office of comprehensive ophthalmologists, especially for the treatment of common eye diseases like choroidal neovascularization in age-related macular degeneration. It is estimated that over four million IVIs were performed in the United States in 2013, a number that is expected to continue to increase. Treatment of retinal disease by intravitreal injection (IVI) has revolutionized the field of ophthalmology. Lorraine Myers (Provencher), MD, David Almeida, MD, PhD, Michael D. They are usually very effective for immediate control of scleritis, stopping the pain and redness within hours to days.Intravitreal Injection Technique A Primer for Ophthalmology Residents and Fellows They may leave a visible deposit of the drug under the surface of the eye for a few months. Injections under the surface of the eye (the conjunctiva) : These injections are done for anterior uveitis or scleritis. Steroids can also be used in those conditions in some cases.ģ. In those conditions, other medications are injected, usually drugs from the "anti VEGF" group. This technique of injection is widely used in the treatment of macular degeneration, diabetic retinopathy and other diseases of the blood vessels of the retina. They are sometimes used if the orbital method has been tried and found not to be effective enough. However the risk of infection, cataract and glaucoma is higher than that of the orbital (external) injections. This method is very effective in reducing inflammation and swelling, as well as in improving the patient's vision. They usually cause immediate floaters (dark shadows moving in the patient's visual field) lasting a few days. These injections have to be done under sterile conditions, to reduce the risk of an infection entering the eye at the time of injection. The material is deposited in the vitreous, which is the clear gel inside the eye. Injections into the eye: Using the intra-vitreal technique, a tiny amount of steroid is injected through the eye wall into the centre of the eyeball. Others needs the odd injection here and there.Ģ. Patients with chronic uveitis sometimes receive multiple injections over the course of their disease. Sometimes more than one injection needs to be given, before an effect is seen. Typically, it has a favourable effect within a week or two. It is commonly used for treatment of macular swelling (macular oedema). It is fairly effective for the treatment of inflammation in the vitreous (the "gel") and the back part of the eye (the retina and choroid). Sometimes double vision may occur for hours to several days. It may be followed by minimal swelling and discomfort for a few hours. The injection is usually given with some local anaesthetic preparation. Injections around the eye (into the orbit): Using the "orbital floor" injection technique (under and/or behind the eyeball): This technique involves injecting a small volume of long acting steroid (triamcinolone, Kenacort) to the tissue just outside the eyeball, usually inserting the needle through the space between the eyelid and the eyeball. These risk increase with increasing number of injections and cumulative dosage.ġ. The main side effects/risks of locally injected steroids are high pressure in the eye (glaucoma) and cataract formation. Patients who need to have injections more than once are usually quite relaxed about it after they have had it done once. However, they are usually painless and sometimes cause very mild and brief pain at the time of the injection. Injections to the eye area obviously create anxiety and fear in patients who have not had them before. These are, generally speaking, very effective treatment options which usually provide control of the inflammatory problem over a period of weeks to several months, depending on the eye, the substance used and the location of the injection. Steroid medications (cortisone derivatives) can be injected locally into or around the eye for the management of uveitis and scleritis. Steroid injections for inflammatory eye problems
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