Intravitreal Injections

Intravitreal injections are used to administer medications to treat a variety of retinal conditions. Age-related macular degeneration (AMD), diabetic retinopathy and retinal vein occlusion are the most common conditions treated with intravitreal anti-VEGF drugs which help to reduce fluid leakage associated with these disorders.

Intravitreal injections are performed in the office by a trained retinal physician. First, the eye and eyelids are anesthetized using drops or gel so the injection doesn’t hurt. Sometimes a small numbing injection may be given. The eye and the eyelids are then cleaned, usually using povidone-iodine, a yellow solution which is very effective at killing bacteria that live around the eye. An eyelid speculum is often used to keep the eyelids open during the procedure. Once the eye is prepped for injection, you will be asked to look in a particular direction depending on the location of the injection while the medicine is injected through the pars plana (the white part of the eye) with a very small needle.

Typically, patients feel pressure, with little or no pain during the injection. After the injection, the speculum is removed and the eye is cleaned. The entire process takes about 10 minutes.

The most promising intravitreal injections for retinal diseases are:

  1. Lucentis (ranibizumab) – FDA approved (6/30/06) intravitreal anti-VEGF drug that provides a significant chance for vision improvement. 33% – 40% of patients receiving monthly injections had vision improvement after one year. Administered once every month for three months and then as recommended by your eye doctor. We were the first and only clinic in Hawaii to participate in the clinical trials that were needed in helping to obtain the information necessary to get Lucentis approved. Also, through our participation in the clinical trials, we were able to make Lucentis available to individual patients before FDA-approval and as early as 2003.
  2. Avastin (bevicazumab) – This is a drug that is FDA approved for the treatment of colon cancer. However, it has also been found to be useful in the treatment of wet AMD. Although it is not the same, Avastin is similar to the smaller Lucentis molecule. Avastin has been used in many clinics around the world as an alternative treatment to help slow down the progression of wet-AMD.
  3. Eylea (aflibercept) – FDA approved (11/18/11) intravitreal VEGF-trap drug that provides a longer acting medication for a significant chance for vision improvement. Eylea is administered once a month for the first three months, followed by once every other month as recommended by your eye doctor. The clinical trials that led to the approval of this medication compared Eylea to Lucentis. These trials showed that the medication was just as effective as Lucentis in maintaining or improving vision in patients with macular degeneration. RCH is proud to have been a part of these trials which lead to the approval of this medication.
  4. Beovu (brolucizumab) – FDA approved 10/8/19 and 6/1/22 for treatment of wet AMD and diabetic macular edema (respectively). Beovu is also an anti-VEGF inhibitor that works to suppress the growth of abnormal blood vessels under the macula and reduce the potential for vision loss caused by fluid leakage into the retina. The recommended dose for BEOVU is 6 mg received by monthly injection for the first 3 treatments then can be given once every 2-3 months.
  5. Vabysmo (faricimab) – Is the first and only FDA-approved (1/31/22) treatment designed to block 2 disease pathways, VEGF and angiopoietin-2 for both wet AMD and diabetic macular edema. The approval is based on positive results across 4 phase 3 studies which consistently showed that individuals treated with Vabysmo at different intervals of up to 4 months achieved non-inferior vision gains versus aflibercept given every 2 months after the first year.