Anti-VEGF Injection Treatment

Anti-VEGF Injection Treatment

Patient Information

Boston House Eye Unit

• Author ID: ER 
• Leaflet ref: Ophth 012
• Version: 4
• Leaflet title: Anti-VEGF Injection Treatment
• Last review: June 2024
• Expiry Date: June 2026

Introduction

You will receive an injection appointment before you leave. It is your responsibility to attend on the date given.

This leaflet is written for patients who have been recommended to have treatment with anti-VEGF drugs or an intravitreal implant, which will be injected into the eye.

VEGF stands for vascular endothelial growth factor, which is a chemical involved in growing new blood vessels in the eye. 

Anti-VEGF treatment is used to treat certain retinal conditions which cause abnormal blood vessels to grow and leak under the retina, which in some cases can lead to rapid loss of central vision. 

A series of injections are given directly into the eye to stop these blood vessels growing and help control the leakage. If you are prescribed an implant, you will need one procedure which will last for a few months.  

This treatment is highly effective. 

Currently there are few different injection drugs that can be prescribed these being LUCENTIS, EYLEA, VABYSMO, Ximulci and AVASTIN. The implants are Ozurdex and Iluvien. It will depend on the Ophthalmologist as to which treatment they prescribe; this will be determined by your vision, scan, and photographs tests.

In which common conditions might this occur? 

• Wet age-related macular degeneration. (AMD) 
• Diabetic macular oedema. (DMO) 
• Retinal vein occlusion. (RVO)
• Myopic choroidal neovascularisation. (MCNV)
• Rubeosis

How is the treatment given? – intravitreal injection or intravitreal implant into the eye

The prescribed drug will be injected in the eye via a device called an inVitrea; this is placed in the eye, and it keeps the eye open and stops you blinking. Sometimes an eye clamp may be used instead, and this will definitely be used if having an implant.  A very fine needle is used, and most patients express a feeling of pressure with minimal discomfort.

When can an injection cannot be given?

• If you are not well e.g. urine infection, chest infection, heavy cold, eye infection or are taking antibiotics for any infection.  If in any doubt, please ring the unit for advice.
• If you have recently had a heart attack or stroke. Please contact the unit. 
• Are pregnant or breastfeeding. 

You must not have any vaccinations a week before or after your injection.

Patient’s responsibility

• Ensure you do not wear your contact lenses for at least 3 days before your planned injection. 
• Do not wear any makeup on the day of the procedure.

Preparing the eye for the injection treatment

The preparation commences in a preparation room. The nurse will explain the procedure, confirm your consent form is in date, and reiterate why the injection is needed, and explain the risks and benefits of the procedure. At this time, she will ask you questions about your health to ensure it is safe to proceed with the treatment.  

The injector will introduce themselves and put an erasable mark on your forehead as to which eye is being injected.  This will be washed off after the injection has been given. You will then be escorted into the clean room (a special room adapted for the sterile treatment), and the eye will be cleaned again by the injector and this solution is left on for three minutes before proceeding to inject the prescribed drug. 

The nurse will administer numerous anaesthetic drops into your eye, which will ensure minimal discomfort when the eye is injected.

A few iodine drops will also be instilled into the eye to be injected and onto the eyelashes and these drops will be timed for three minutes. 

The eye to be injected will have the eyelids and surrounding area cleaned with an antiseptic solution called iodine. A few iodine drops will also be instilled into the eye and onto the eyelashes. 

Why is iodine used to clean the eye?

Research has confirmed that using iodine before giving an intravitreal injection minimises the risk of infection. Sometimes the iodine can cause sensitivity, and this is because it is the same group as chlorine, which is used in swimming pools. Some patients experience a mild to moderate irritation and redness, but this does not mean that you are allergic to the solution. This irritation will settle usually within 24 hours.

Allergy to Iodine

If you state you have an allergy to iodine, the nurse will proceed and complete a patch test to confirm this. This test takes 24 hours to confirm if you have a true allergy. We can use another antiseptic agent, which is chlorhexidine. However, this is not the preferred choice as it is not as effective as iodine. 

What are the risks of having an intravitreal injection?

With any medical treatment there will always be a small risk of complications occurring.  It may be from the injection itself or the drug injected. The benefits will outweigh the risks. 

Before your injection procedure, the risks will be explained in detail as documented on your consent form and any questions answered. 

Some common side effects that can occur after the injection: 

• Red eye – you may see a bleed or bruise on the white part of the eye where it was injected.  This usually resolves within a week without treatment. 
• Floaters – blobs or specks in your vision. 
• A sore, gritty eye which may also ache. This usually settles within 24 hours but if it is very uncomfortable it is advised to take some pain relief i.e. Paracetamol. 
• Raised intraocular pressure which is quite rare – If this happens, you will be in a lot of pain that will not settle with pain relief therefore you would need to contact the unit for advice. 

A leaflet will be given to you after your injection with all the common side effects and who to contact if you have any concerns or problems.  We encourage patients to ring the unit immediately for advice. 

When and how to contact us

Contact the unit immediately if:

• your eye becomes progressively red
• you have sticky discharge
• you become sensitive to light
• your vision suddenly goes worse 
• if you have any other concerns

Important information that must be adhered to after your treatment

• If you feel that your eye needs cleaning the morning after the injection, please use cool boiled water and clean lint. Wash your hands first and with a wet piece of lint, do one wipe from the inner part of eye, outwards. Repeat this with a fresh piece of lint each time until the eye is clean. 
• Do not touch the eye as it is anesthetized. You could cause a corneal abrasion which is a scratch on the front surface of the eye which can be painful. You should contact the unit if this happens. If the eye is watering use a fresh tissue to catch the tears. This will settle down. 
• Do not return to wearing makeup for 3 days as this could cause infection. 
• Avoid getting water, shampoo or soap into the eye for 3 days. 
• No swimming for 3 days. 
• Do not wear your contact lenses for 3 days. 
• Refrain from gardening or dirty tasks for 3 days. 
• If you use existing drops for glaucoma or dry eyes, these can be used as prescribed. Remember to wash your hands and ensure the tip of the bottle does not touch the eye. 

Note if you are going on holiday abroad it is advisable to have your injection at least 3 days before flying. 

If after reading this leaflet you have any concerns or require further information. Please discuss with a member of the nursing team. 

Keep this leaflet safe so you can refer to it each time you have an injection.

Contact details:

Boston House Eye Unit is open Monday to Friday 08:30am to 5pm.  During this time, please contact us on the following number if you are concerned:

Boston House Eye Unit:  01942 773116 Or 01942 822244

Outside of these hours you may attend your local A&E department.

The A&E department at RAEI Wigan is open 24 hours a day and is contactable on:  01942 822440. 

They may refer you to a specialist eye unit in Manchester or Liverpool.

If you wish to contact Manchester or Liverpool eye units directly when Boston House eye unit is closed, they are available on the following numbers:

Manchester Royal Eye Hospital: 

0161 276 5597 

Royal Liverpool Eye Hospital:               

0151 706 2000 Ext 3955 or 0151 706 3955