PATIENT INFORMATION SHEET
You are about to begin a course of intravitreal injections for either exudative (wet) ARMD, non-ARMD choroidal neovascularization, diabetic macular oedema, retinal vein occlusion with macular oedema, or other rare causes of macular oedema. This is a well-established treatment and should be administered and monitored carefully.
Prof. Michaelides will have discussed and agreed with you which intravitreal injection option to proceed with. In principal the injections are given every 4 to 12 weeks and may need to continue for 2 years or even longer. This typically means repeated injections over 2 years (e.g. for wet ARMD patients this may be 8 injections in the first year and four in the second, but more if treatment is required for longer). We believe some patients will stabilise before two years, and therefore require fewer injections.
Assessments of your condition, will be performed by clinical means, fluorescein angiography, optical coherence tomography (OCT), and OCT angiography, prior to the first injection, and by clinical means prior to each subsequent injection with further investigations performed as necessary and depending on response.
After the final injection, it is recommended that you are followed for at least a year to ensure the condition remains stable. After each injection, please contact Prof. Michaelides’s Practice Manager to arrange the next injection date.
Prof. Michaelides is currently performing the injections at The London Medical in a dedicated intraocular injection room on Mondays all day and Thursdays from 2pm onwards. Please arrive 30 minutes before your injection time. A nurse will measure your visual acuity, intraocular pressure and insert pupil dilating drops and likely perform an OCT scan i.e. high-resolution 3D image of the centre of the retina, the macula. Prof. Michaelides will see you immediately before the injection, administer anaesthetic drops, check clinical findings and answer questions etc.
The injection itself involves you lying down on a couch in the dedicated injection room for ten minutes. During this time, Prof. Michaelides will scrub up, put on sterile gloves, sterilise around the eye with a solution of iodine and perform the injection, which takes less then 5 seconds and which you will hardly notice. You may be aware of a light being shone into the eye at the end of the procedure which is done by Prof. Michaelides to check inside the eye.
The most serious complication of a course of intravitreal injections is the risk of infection in the eye, known as endophthalmitis. This risk is approximately 1% for a course of injections, or 0.1% per injection. If it does occur, it can make the vision significantly worse permanently, and needs to be dealt with immediately.
After each injection, the eye will be a little tender for a few hours, and you may experience a few floaters, and occasionally a small bubble at the bottom of your visual field in the injected eye. These are expected and typically settle over 24 hours. Antibiotic drops are not routinely given after injection as evidence suggests they may slightly increase the risk of infection in the eye. You will however be given lubricant drops in case the eye feels dry or irritable post injection. Prof. Michaelides or his secretary will contact you approximately 3 days after the procedure to check that everything has settled well and that you have no untoward symptoms. If you note the onset, often quite rapidly, of blurred vision, increasing redness, pain or light sensitivity in the injected eye, at any time after the injection, but particularly in the first 72 hours, please contact immediately:
Prof. Michaelides’s secretary: 07770-870392 OR
Prof. Michaelides directly on: 07854-003821.
In the unlikely event you cannot get through on either number then please report immediately to Moorfields Eye Hospital Accident and Emergency Department, which is open 24 hours, 365 days a year:
Contact no. 0207 253 3411 ext 2080.
If Prof. Michaelides is away or attending a conference, he will ask another Consultant, who is also experienced in the use of intravitreal injection to be available to cover his patients.
One Patient, a retired Journalist, wrote about her first intravitreal injection:
’I am feeling quite euphoric today, the day after my first treatment. Yesterday I was quite simply frightened, as I suppose most people must be at the prospect of having an injection into an eye. I had been assured that the procedure would not be as bad as it sounded and that I would feel very little of the injection. I was not sure I believed him – medical persons’ ideas of what constitutes a little or a lot of pain can be very different from mine. So, I went through the preparations quaking, half convinced that something seriously painful was going to happen to me and worrying that I would not be able to keep my head or my eye still. By the time I was in theatre I was very tense.
The process was not as frightening as I expected. First my eyelids were held back and anaesthetics and an antibiotic dripped into my eye. Each of the two anaesthetics stung a little, but not nearly as much as getting soap in an eye. Then my eyeball was firmly pressed for what seemed like half a minute. When that pressure was released I felt a slight prick, but I had been asked to look in another direction and saw no needle. If I had, I might have run away, as I once did at the dentist’s.
Someone had told me the whole injection took around twenty seconds. I started mentally counting ‘hackety-packety one, hackety-packety two…’. Long before I reached twenty the whole thing was over. I had felt a second little prick and a gentle pressure in my eye when I assume the fluid went in: not very comfortable, but nothing that could be classed as pain.
I can honestly say that the greatest discomfort I felt was from the very bright lights needed to see into my eye after the injection. So yes, I am feeling euphoric. I can continue with the treatment. I may not look forward to the next injection, but I don’t dread it either.’
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