Diabetic eye disease can cause permanent damage to retinal capillaries that makes them leaky, resulting in macular oedema.
The fluid that leaks out of the blood vessels makes the macula “waterlogged” and swollen. The fluid collects in oval spaces known as ‘cysts’. Swelling of the macula due to diabetic macular oedema results in reduction in the quality and quantity of the central vision.
There are a number of treatment types for diabetic macular oedema, and the choice of treatment depends upon a number of factors. Intravitreal injections are currently the main type of treatment with good evidence that early treatment results in a better visual outcome.
What Type Of Drugs Are Used?
As of 2016, there are a number of different types of drugs that are used to treat diabetic macular oedema. These include anti-VEGF drugs (which are also used to treat other conditions), as well as steroid injections.
Whilst anti-VEGF drugs are currently the preferred treatment, the most appropriate drug is dependent upon a number of factors; Dr Chauhan will consider these prior to suggesting which is most suitable.
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How Often Do I Need To Have These Injections?
Injections for diabetic macular oedema are generally given following a DRCR net (Diabetic Retinopathy Clinical Research network) protocol, and aims to provide the best treatment and visual outcomes.
Injections are given monthly for approximately six months, or until the diabetic macular oedema completely resolves; following this injections are given as required if the macular oedema recurs. On average, this means that treatment is intensive during the first year (six injections during the first six months, nine in total within the first year, with regular examinations). However, for the second year the average number of injections required reduces significantly to 2-3 injections, and examinations become less frequent as the condition generally stabilises.
How Is The Injection Given?
The intravitreal injection (injection straight into the vitreous of the eye) is given in a clean environment in order to reduce the risk of infection. Most patients are concerned about 4 issues:
WILL IT HURT?
No. You will have anaesthetic drops instilled into your eye about three times about ten minutes apart by a nurse or orthoptist. At this stage your eye would already be numb enough for a cataract operation. The injection itself is extremely quick and you will feel a sudden and split-second feeling of pressure. Almost every patient has a “is that all there is to it”? response after their first injection.
HOW WILL I KEEP MY EYE OPEN FOR THE OPERATION?
Your eye will be held open gently with the gloved fingers of the injecting doctor.
HOW WILL I KEEP MY EYE STILL FOR THE INJECTION?
You will be asked to look at a particular point on the ceiling. This will keep your eye still.
WILL I BE ABLE TO SEE THE NEEDLE?
No. The injection is done from the side and you will not see it at all.
The nurses will test your vision immediately after the injection and will then apply ointment and an eye pad. You may then go home, usually about an hour and a half after entering the clinic. The eye pad should stay on, untouched, for 4 to 6 hours and should then be removed at home. You should then put the gel that you’re given in your injected eye every 1 to 2 hours until you go to sleep. When you wake up the next day, your eye should be comfortable.
You will be provided with the gel before you leave. You will also be given instructions and several contact telephone numbers in case of problems.
What Are The Risks Of Intravitreal Injections?
Before you are treated, you need to know the risks and benefits so you can make an informed decision.
Side effects are uncommon with intravitreal injections. Some are related to the injection itself, and some due to the drug itself.
Chances of injection-related risks:
- Infection: less than 1/2000*
- Severe bleeding into the eye: less than 1/1000*
- Retinal detachment: less than 1/1000*
- Persistent high pressure in the eye: less than 1/100*
- Cataract: less than 1/1000*
- Allergy: less than 1/1000*
- Inflammation: less than 1/1000* (* for each injection)
Intravitreal drug-related risks:
As with any drug, there are a number of potential side effects related to intravitreal injections. Aside from the previously mentioned ‘injection-related risk’ (mentioned above), these potential side effects are different depending upon which injection drug (anti-VEGF or steroid) is suggested by Dr Chauhan.
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