An Intravitreal injection is a treatment for various conditions related to the retina. A small volume of medication is injected into the vitreous - the jelly located in the space between the lens of the eye and the retina. Using this treatment, we can quickly and effectively deliver the required drug to the area to treat and control retinal conditions such as macular degeneration, retinal vein occlusions, diabetic maculopathy and choroidal neovascular membranes from any cause.

In addition, the treatment is considered very effective and painless.

Intravitreal Injection Quick Links

How do I know if I need Intravitreal injections?

Age-related macular degeneration

What causes Age-related macular degeneration?

Diabetic retinopathy

Diabetic maculopathy

What causes Diabetic maculopathy?

Retinal Vein occlusion

What causes Retinal vein occlusion?

Other conditions

What should I expect from my Intravitreal injections?

How long will it take to recover after Intravitreal injections?

Will I need to take time off from work after an Intravitreal Injection?

Can I have Intravitreal injections in both eyes at the same time?

Intravitreal injections

Intravitreal, pronounced “In tra vit re al”, literally means “into the vitreous of the eye”. The injection allows us to administer the medication directly to the eye cavity that contains the vitreous. The vitreous is a gel-like fluid containing tiny fibres attached to your retina.

Age-related macular degeneration (AMD), diabetic retinopathy, retinal vein occlusions and choroidal neovascular membranes are the most common conditions for needing Intravitreal injections.

The symptoms of these conditions vary but include:

• Reduced central vision and visual disturbance

• Visual distortions - straight lines may appear wavy or bent

• Colours appear less bright

• Difficulty with low light levels and moving between differing light

• Increased blurriness

• Difficulty reading print

• Problems with detail like recognising faces

Age-related macular degeneration can cause progressive central vision loss that is not recoverable without treatment. 90% of significant sight loss is due to age-related macular degeneration. You will never lose your peripheral vision from this condition, though.

Age-related macula degeneration (AMD) is caused by a combination of genetic and environmental factors, along with ageing or degeneration (wearing away) of a supportive layer behind the retina. This supportive layer (The Retinal pigment Epithelium) provides nourishment and pumps away waste material. However, when this layer degenerates, it can cause thinning, a build up of waste material under the retina and ultimately damage to the tiny cells that capture light within the retina. This phenomenon is often termed dry or atrophic AMD and currently does not have any definitive treatment. 

In approximately 10% of patients, this is complicated by the growth of a blood vessel through the faulty supportive layer (termed a Choroidal neovascular membrane). These blood vessels can leak fluid or bleed into or under the retina and cause rapid visual deterioration. This phenomenon is termed wet macula degeneration, and this can be treated with intravitreal injections of a drug called AntiVEGF to stabilise vision and prevent worsening. The sooner treatment is initiated, the better. The patient often requires regular treatment for many years, and timely treatment gives the best result.

Diabetic retinopathy includes diabetic maculopathy. This retinopathy involves the macula's central, most sensitive part of the retina. Though diabetic retinopathy also encompasses pathology that affects the outside retina and sometimes the front of the eye, the primary use of intravitreal injections in diabetic patients is for maculopathy. In addition, there is evidence for effective use of intravitreal injections in proliferative retinopathy, but most commonly, laser is the preferred treatment for this.

• Sudden or gradual vision loss

• Central visual blurring

• Visual distortions - straight lines may appear wavy or bent

• Colours appear less bright

• Increased blurriness

• Difficulty driving and reading print

• Problems with detail like recognising faces

Without treatment, diabetic maculopathy can lead to poor vision or even blindness from damage to the tiny cells that capture light within the retina.

Diabetic retinopathy is seen in people with diabetes primarily due to high blood sugar levels. Diabetes damages small blood vessels throughout the body, causing several medical conditions. Additional medical problems, including high blood pressure, high cholesterol, and kidney damage, can exacerbate diabetic maculopathy. Periods of pregnancy, illness, rapid sugar control and some medications can also accelerate maculopathy.

The blood vessels that supply oxygen and nutrients to the retina can become leaky, and fluid can build up within the retina. If this is bad enough, it may cause the symptoms. However, this fluid will not be the only cause of visual disturbance as the oxygen supply to the retina may also be affected.

Intravitreal injections of a drug called antiVEGF or similar may be beneficial and aim to prevent worsening of vision and can often improve vision significantly and to its best potential in many patients if maculopathy develops. Usually, patients need frequent intravitreal injections to gain control over the fluid and often need regular injections that become less frequent over time.

• Blurring in part or all of the field of vision

• Sudden or gradual loss of vision

• Dark spots or lines in the field of vision

• Central visual blurring

• Visual distortions - straight lines may appear wavy or bent

• Colours appear less bright

• Increased blurriness

• Difficulty driving and reading print

• Problems with detail like recognising faces

Without treatment, Retinal vein occlusion can lead to complete loss of central vision and irreversible scarring.

Retinal vein occlusion is usually caused by compression or narrowing of the retinal vein by the thickening of an adjacent artery. There are several other causes, but most patients are likely to have associated medical conditions, including high blood pressure, high cholesterol levels and diabetes. Other rarer causes of retinal vein occlusion are seen too. For example, patients may have a clot in the main vein that exits the eye (Central retinal Vein occlusion) or in a branch of the veins within the retina (Branch retinal vein occlusion).

In both groups of patients, this can cause increased pressure within the vessel, leading to the leaking of fluid and blood into the retina. When this leakage occurs in the central part of the retina, the macula, the symptoms above may develop. However, this fluid will not be the only cause of visual disturbance as the oxygen supply to the retina may also be affected.

Intravitreal injections of a drug called antiVEGF or steroids may be beneficial and aim to prevent worsening of vision and can often improve vision significantly and to its best potential in many patients if maculopathy develops. Usually, patients need frequent intravitreal injections to gain control over the fluid and often need regular injections that become less frequent over time.

• Choroidal neovascularisation (CNV)

  • This can be secondary to various eye problems, including inflammation, central serous retinopathy and previous scar tissue.

• Myopic CNV (in patients who are short-sighted)

• Proliferative retinal disease

• Rubeosis (blood growth at the Iris)

The procedure is incredibly quick and painless. The procedure will take 5-10 minutes, but most of this time is preparation only, and the injection itself lasts only moments. You will usually have a review prior to the injection to see how the eye is responding, so the appointment is likely to last 15-30 minutes.

You will be semi-reclined and have lots of anaesthetic drops. The eye will be cleaned, and a clear plastic drape will cover the eye. A small metal clip will hold your eyelids open to stop you from blinking. As a result, you will look away during the injection and not be able to see the instruments in front of you.

Most patients describe the sensation as a pressing of the eye that lasts a few seconds. There is mild discomfort or pressure that lasts only a few seconds in some cases. You may see some floaters or a swirl of the medication as it enters the eye, but this is not unpleasant. Some patients worry that they will move while the injection is taking place but rest assured that this is something that is anticipated and manageable during injections.

After the procedure has taken place, your eye will be cleaned, and you will be asked to continue with eye drops that will be provided to you on the day.

You may find the eye is gritty or a little sore for a day or two after the procedure. Occasionally it may be red over the site of the injection. A cold compress held gently over the eye can relieve some discomfort.

Your eye will heal without intervention within one day of the procedure.

Only for the day of the procedure. You should not need to take any time off work, but we suggest you book your appointment during your days off as you will be unable to drive for the first 6-9 hours after the procedure, and most patients find they need to rest for the remainder of the day.

Yes. Often patients have the same condition in both eyes, and we perform injections in both eyes, with separate procedures one after the other.

If you wish to know more about our Intravitreal injections, our team of specialists will be able to go through all the details of the procedure as well as discuss your medical history and diagnoses.

Intravitreal injections – MR LIAM SULLIVAN - CONSULTANT OPHTHALMOLOGIST MB CHB, FRCOPHTH

I perform intravitreal injections for all macula and retinal diseases, including wet age-related macula degeneration, diabetic macula oedema, central retinal vein occlusion, branch retinal vein occlusion and all types of choroidal neovascularisation (CNV) including myopic CNV and inflammatory CNV and proliferative retinal disease.

I have performed well over 5000 injections and supervised many, many more. I have an outstanding success rate with no post-operative endophthalmitis, bleeds or other complications which can occur through this procedure.

I perform all types of Intravitreal injections as a one-stop service (at the same time as review) at outpatient treatment at the clinic. I am also on hand to perform this procedure in an emergency or on very short notice.

I lead the intravitreal injection service at Addenbrookes and train all staff who participate in the unit and run simulated training programmes.