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This is an effort from Neoretina Eyecare Institute to
provide the right information that makes your more knowledgable about your eyes.
 

Outpatient treatment

 

Intravitreal injections(intraocular injections)

•    Vitreous  refers to the   transparent  gel   like substance   inside of the eye  that is present behind the lens.
•    The part of the eye that is in front of the lens is referred to as anterior chamber  and  portion of the eye  that is behind the lens is referred to as posterior chamber.
Anterior chamber is filled  with fluid called aqueous chamber and the posterior segment is filled with vitreous gel .  
•    Commonly administered eye drops penetrate only to the anterior segment to some extent and little or none to the posterior segment.  Vitreous penetration of commonly prescribed oral medications is poor due to presence of blood retinal barrier which segregates the inside of the eye from rest of the body.

•    Intravitreal injections have become the standard way of drug delivery to the posterior segment

•    Currently the available drugs labeled for intraocular use  includelucentis , macugen , ozudrex .

•    Off label triamcinolone,antibiotics and avastin are being given regularly worldwide .

•    Avastin ,lucentis and macugen come under the category of anti vascular endothelial growth factors(anti VEGF) whereas triamcinolone is a long acting steroid and ozudrex is a biodegradable steroid implant.

Indications for intravitreal injections

•    Wet age related macular degeneration( choroidalneovascularmembrane,CNVM ARMD)

•    Macular edema – caused by central retinal vein occlusion, branch retinal vein occlusion,and diabetic retinopathy

•    Selected cases of proliferative diabetic retinopathy

•    Endophthalmitis

Preinjection instructions:

Antibiotic drops are generally advised to be started atlest 4 times aday  at least a day prior to the injection as a routine protocol to as  a prophylaxis against infection.

Injection procedure:
Injections are generally give in the operating rooms under strict asceptic precautions. Anaesthetizing drops are given to make it a pain free procedure and eye is patched  for about an hour following the procedure . Patients can resume their duties the following day and can travel.

Post injection instructions:
The eye is not usually painful and does not need to be covered. It may be a little bit
gritty.  The vision is not expected to improve until at least 1 month following the procedure, so not be disappointed if there appears to be no change in your vision at first. If steroid is injected (Triamcinolone) the vision may be worse due to the opaque nature of the drug.
1.Antibiotic eye drops are required 4 times per day for 4 days.

2. Eye should not be rubbed.

3. You may take a shower and wash your hair normally, but try to avoid getting water in your eyes.

4. Any discharge on the eyelids can be cleaned gently with some cotton-wool moistened
with warm water.

5. If the vision deteriorates significantly or the eye becomes acutely painful then please
contact the doctor immediately as they may be symptoms of endophthalmitis.


Complications :

1. Intraocular infection (endophthalmitis) is a practical concern for  all the intravitreal injections . However the rate is very low(1/1000) and can be managed successfully with immediate appropriate management.

2.Progression of cataract and raised intraocular pressure are of concern with steroid injections like traimcinolone so frequent follow up after the injections is recommended.
Intravitreal injections successfully deliver the drug to the site in need i.e , inside the eye and thus have gained intense popularity in successfully managing various diseases of the retina. Most of the cases  the benefits of intravitral injections far outweigh the risks involved.
 

Laser photocoagulation:
Laser is an intense beam of light that can be precisely focused to treat certain diseases of the retina.Laser is a beam of light which is focused on to the retinal using special lenses and equipment to bring in the desired effect. Most commonly it is used to stop the leaking vascular anomalies i e microanuerysms in the macula( commonly called focal laser generally done in single sitting) or to cause regression of abnormal vessels on the retina and optic disc(neovascularization).
 Laser for regression of neovascularization is done for advanced stages of proliferative diabetic retinopathy and is generally achieved by pan retinal photocoiagulation which is done in multiple sittings occasionally up to 4 or 5 sittings .
It is also used to treat symptomatic  retinal tears (flashes) or prophylactically for  lattice degeneration in patients with high risk of progression to retinal detachment( fellow eyes with retinal detachment or high myopes, family history of retinal detachment).

Most commonly done laser for retinopathies is the green laser ( 532 nm, visible spectrum ). The other less frequently   used laser is 810 nm diode laser in the infrared spectrum.
Green laser is commonly used to treat diabetic retinopathy, retinal tears as well retinal vein occlusion.
Delivery system of laser is generally of three types.
1) Slit lamp delivery ( most commonly used equipment in eye OPDs) 

Laser being delivered through slit lamp
2) Indirect Ophthalmoscopy delivery: indirect ophthalmoscope is used  frequently by retinologists to examine the retinal periphery. Laser indirect ophthalmoscope (LIO) is used to deliver laser to the extreme periphery of the eye in a non invasive manner(non contact  ). It is most commonly used to treat infants for retinopathy of prematurity or in adults who are uncooperative for contact slitlamp delivery system.
3)  Endolaser :It is done as part of complex retinal detachment and vitrectomy surgeries intraoperatively  in the operation theatres.
Most of the retinal  laser procedures are done routinely in the  OPD. The anaesthesia is also given in the form of eye drops. There is no patch or bandage applied  following laser and can resume routine activities couple of hours following the procedure.
Types of laser:
1.    Macular lasers: It may be focal or grid pattern of laser photocoagulation most commonly it is used to stop the leaking vascular anomalies i e microanuerysms in diabetic maculopathy.

2.    Scatter photocoagulation: It may be  in the form of sectoral scatter photocoagulation as in case of branch retinal vein occlusion with neovascularization or panretinal photocoagulation in case of proliferative diabetic retinopathy where the the purpose of treatment is to treat the damaged retina so as to preserve the function of normal retina.
3.    Barrage laser: This type of laser photocoagulation is done surrounding the areas of retinal holes or breaks so as to prevent fluid from detaching the normal retina.
 















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