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TreatmentofDiabeticMacularOedemawithIntravitrealInjection
ofAnti-VEGFDrugsNameofConsultant:Address:Telephone:Emergencycontactdetails:
IntroductionYouhaveaneyeconditioncalledDiabeticMacularOedemaDME.TreatmentforDMEisbyinjectionofmedicineintothebackoftheeyeknownasanintravitrealinjection.Inordertoundergothistreatment,youhavetogiveconsentandtosignthehospitalconsentformwhereappropriate.Beforeyousigntheconsentform,itisimportantthatyoufullyunderstandthetreatmentyouareabouttohave,includingalternativetreatmentsandanyrisksorside-effects.
WhatisDiabeticMacularOedema?
DiabeticMacularOedemaisaleadingcauseofvisualimpairmentintheadultpopulation.Itoccursasadirectcomplicationofdiabeteswhichresultsindamagetothebloodvesselsinthecentralretinamacula.Asaresultthesebloodvesselsleakfluidintothemaculawhichleadstolossofvision.Withouttreatment,centralvisionlossmaybesevereandpermanent.
HowisDiabeticMacularOedematreated?
TreatmentofDMEcannotundothechangesalreadypresentintheeye,andthemaingoaloftreatmentisthereforetopreventfurtherlossofvision.Anti-VEGFdrugsaregivenbyinjectionintotheeyeandacttosloworstoptheleakagethatcauseDME.Althoughsomepatientshaveregainedvision,most
patients’visionwillstabilise.Anti-VEGFinjectionsmaynotrestorevisionthathasalreadybeenlost,anddonotalwayspreventfurtherlossofvisioncausedbythedisease.
Howisthetreatmentgiven?
Eyedropsareadministeredtodilatethepupilandsterilisetheeye.Oncethepupilisdilated,theactualproceduretakesaroundfifteenminutes.Youwillbebroughttotheprocedureroom,andaskedtolieinacomfortablepositiononatrolley.TheeyeisnumbedwithanaestheticdropsandwashedwithIodine.Theeyelidsareheldopenwithaninstrumentcalledaspeculum.Themedicationisinjectedintothevitreoushumour,whichisthejelly-likesubstanceinsidethebackoftheeye.Youmayexperienceslightdiscomfort,afeelingofpressure,orasharpfeelingontheeyeatthetimeofinjection.
Anti-VEGFinjectionsarerepeatedintoyoureyeonceamonthforfourtosixmonths,andthereafterasneededatregularintervals.Yourophthalmologisteyedoctorwilltellyouhowoftenyouwillreceivetheinjectionsandoverwhatlengthoftime.Itisoftennecessarytoattendforeyeexaminationsand/orinjectionsonamonthlybasisandperhapsforseveralyears.
Whatothertreatmentoptionsareavailable?
OtherformsoftreatmentareavailableforDiabeticMacularOedema.LaserPhotocoagulationcanbeusedtosealtheleakingbloodvesselsthatresultinDME.However,althoughlasercanreducetheriskoffurtherseverevisionloss,itdoesnotofferimprovementinvision.Someotherdrugsgivenbyinjectionaresometimesused.Theseoptionscanbeexplainedtoyoubyyoureyedoctor.
Youdonothavetoreceivetreatmentforyourcondition;however,withouttreatmentyourcentralvisionmaycontinuetoworsentothepointwheretreatmentmaynolongerhelp.
AlthoughDMErarelycausescompleteblindness,itcanreducethevisiontothepointwherereadinganddrivingarenotpossiblebecauseoflossofcentralvision.
Whataretherisksoftreatment?
Risksofintravitrealeyeinjections
Allsurgicalprocedureshaveaninherentrisk.However,thevastmajorityofpatientshavenoseriousproblem.Seriouscomplicationsoftheintravitreal
procedureincludeinfectionendophthalmitis,retinaldetachment,cataractformationandvitreoushaemorrhage.Anyoftheseseriouscomplicationsmayleadtodecreasedvisionand/orhaveapossibilityofcausingblindness,orevenlossoftheeye.Intheclinicaltrials,thesecomplicationsoccurredatarateof
lessthan0.1%ofinjections1inevery1,000cases.Otherseriousevents,suchasinflammationwithintheeyeandincreasepressureintheeye,occurredatarateoflessthan2%lessthan2outofevery100intheclinicaltrials.Additionalproceduresmaybeneededtotreatthesecomplications.
Whattoexpectafteraninjection
•Aftertheinjection,youmayhaveagrittyfeelingandtheeyemaylookbloodshotforafewdays.
•25%ofpatientswillexperienceabloodspotonthesurfaceoftheeyeatthesiteoftheinjection.Thiswillnotalteryourvision.
•Youmayseefloaters,whichwillbecomesmallerandwilldisappearoveronetotwoweeks.
•10%ofpatientsmayexperienceeyepainrelatingtothepre-injectionpreparationprocedureeyelidspeculum,eyedrops,eyewash.
•7%ofpatientswillexperiencevitreousfloatersorspotsinthevision.
•Lessthan10%willexperienceabrasionofthecornea,inflammationoftheeyeandvisualdisturbance.
•8%ofpatientswillexperienceariseinintraocularpressure
•7%ofpatientswilldevelopavitreousseparation/vitreousdetachment
Duringfollowupvisitsortelephonecalls,youwillbecheckedforpossibleside-effects,andtheresultwillbediscussedwithyou.
Complicationsofanti-VEGFdrugsinotherbodyparts
Thereisatheoreticalincreasedriskofexperiencingbloodclots(suchasmaycauseheartattackorstroke)afterintravitrealadministrationofanti-VEGFdrugsthateffectthegrowthofbloodvessels.However,alowincidenceoftheseeventswereseenintheclinicaltrials.Patientswithahistoryofstrokemaybeatgreaterriskforanotherstroke.Ifyouhaveahistoryofstroke,pleasediscussthiswithyoureyedoctor.Lowlevelsofanti-VEGFdrugscanreachyourbloodstreamafterinjectionintotheeye.
Coincidentalrisk
Wheneveramedicationisusedinalargecohortofpatients,coincidentalproblemsmayoccurthatcouldhavenorelationshiptothetreatment.Forexample,patientswithhighbloodpressureorsmokersarealreadyatincreasedriskforheartattacksandstrokes.Ifapatientbeingtreatedwithanti-VEGFdrugssuffersaheartattackorstroke,itmaybeasaresultofapatient’shighbloodpressureand/orsmoking,andnotnecessarilyduetothetreatment.
Yourconditionmaynotgetbetter,ormayevenbecomeworsedespitetheseinjections.
Thistreatmentmightnotbeeffectiveforyou.
Patientresponsibilities
Contacttheemergencynumberyouhavebeengivenorattendtheeyeaccidentandemergencydepartmentifyouexperienceanymajorproblemsafteraninjection.
Problemssuggestiveofaninfectioncaninclude:
•Eyepainasagainstthenormaldiscomfortaftertheprocedure
•Blurringornewdecreasedvisionasagainstaftertheprocedure
•Extremelightsensitivity
•Pusorotherdischargecomingfromtheeye
YOUcanhelppreventorreducetheseproblems:
1.Donotrubyoureye.
2.Donotgoswimmingforfivedaysaftereachinjection.
3.Washyourhandscarefullybeforeyouapplytheeyedrops.
4.Avoidstrenuousactivityandliftingheavyobjects.
5.Avoidgettingsoaporshampoointoyoureye.
6.Avoidwearingeyemake-upforuptooneweek.
7.Callyoureyedoctorophthalmologistrightawayifyounoticeanyoftheabovelistedsymptoms.
8.Keepallfollowupappointments.
Ifthereareanysignsofeye/eyelidinfectionpresentonthedayofyourplannedinjection,yourtreatmentmayneedtobere-bookedforanothertimetoallowcontrolofsuchinfection.
Pleaseinformyourdoctorifyouhaveastickyordischargingeye.
IrishCollegeofOphthalmologistsTheIrishCollegeofOphthalmologistsICOisthetrainingandprofessionalbodyforeyedoctorsinIreland.TheICOisdedicatedtopromotingandsettingthehigheststandardsofexcellenceandpatientcareinthepracticeofophthalmologyinIreland.Wedothisbyeducatingeyedoctorsintraining,providingon-goingeducationforeyedoctorsinpractice,givingaccuratemedicaladvicetothepublicandpolicyguidancetothegovernment.Forfurtherinformation,visitwww.eyedoctors.ie