An Anti-VEGF Injection is a common treatment for when abnormal blood vessels develop and bleed in the back of the eye. Of course it may sound off putting to have an injection in your eye but the area is numbed, we take great care to sterilize everything, and the process only takes seconds. This guide goes over the Eye Injection Procedure, the use of an Intravitreal Injection, what the benefits and risks are, and what to expect during Eye Injection Recovery.
What Is an Anti-VEGF Eye Injection?
VEGF is an acronym for vascular endothelial growth factor which is a protein in charge of blood vessel growth. In some retinal diseases VEGF activity is in overdrive which in turn causes the growth of weak vessels or their leakage. Fluid or blood may accumulate in the retina at the macula’s nearby area which is the part of the eye that is used for reading, recognizing faces and fine detail.
An Anti-VEGF Injection does that. What it does is reduce leakage and abnormal blood vessel growth which in turn may decrease retinal swelling, stabilize sight and at times improve vision. The National Eye Institute reports we use anti-VEGF medicines for diabetic retinopathy, macular edema related to diabetes or retinal vein occlusion, and wet age related macular degeneration.
The medicine is administered via an Intravitreal Injection which puts in a very small dose into the vitreous gel within the eye right by the retina. MedlinePlus reports that this method of delivery puts a greater concentration of medication near the retina which is the area of treatment.
Which Conditions May Need Treatment?
A retina specialist may recommend an Anti-VEGF Injection for wet age related macular degeneration, diabetic macular edema, diabetic retinopathy, macular swelling from retinal vein occlusion, or abnormal blood vessel growth related to severe myopia. That decision is usually based on a detailed retinal exam and tests like optical coherence tomography which is also known as OCT.
An Intravitreal Injection will be that which we plan out based on the diagnosis, scan results, prior response to treatment and the health of the patient in general. We may do this to reduce retinal fluid, to control bleeding, to preserve central vision or to limit further damage.
| Condition | Why treatment may be advised | Main goal |
| Wet age-related macular degeneration | Abnormal vessels leak fluid or blood near the macula | Protect central vision |
| Diabetic macular oedema | Damaged retinal vessels cause macular swelling | Reduce fluid and improve retinal function |
| Diabetic retinopathy | Fragile new blood vessels may grow and bleed | Lower the risk of progression |
| Retinal vein occlusion | Blocked retinal circulation leads to swelling | Control oedema and monitor recovery |
| Myopic choroidal neovascularisation | Severe myopia may cause abnormal vessel growth | Limit leakage and central retinal scarring |
How Does the Medicine Work?
An Anti-VEGF Injection doesn’t remove retinal tissue or replace the eye’s natural lens. What it does is to block chemical signals which cause unwanted growth and leakage of blood vessels. This category of medication includes ranibizumab, aflibercept, bevacizumab, brolucizumab and faricimab which the ophthalmologist will choose from for each patient. The National Eye Institute reports these as commonly used anti-VEGF treatments.
The effect is not permanent. Some patients do in fact require monthly treatments at first which then lengthen out as the eye stabilizes. Others may have to continue with the treatment to protect what vision they have left. For each Anti-VEGF Injection the schedule should be based on retinal exam and OCT results which in turn will tell us what is going on rather than what worked for another patient.
Preparing for the Eye Injection Procedure
Before the Eye Injection Procedure patients should report to the retina team if they have had eye redness, discharge, recent infection, allergies, pregnancy, are breastfeeding, have bleeding problems, have had recent surgery and are taking any medications. Also they should disclose if they have had a recent heart attack or stroke. At the advice of Cambridge University Hospitals we tell our patients to report recent infection, history of antibiotic use, pregnancy, if they are nursing, a past heart attack or stroke because these issues may play a role in our treatment schedule.
Patients at times will be able to eat, drink and take their regular medicines which is at the discretion of the doctor. For transport arrangements to be made — it is wise to do so because some patients may have had dilating drops which at that time make driving unsafe or may still be experiencing temporary blurred vision. Also the doctor may do a vision test, do a retinal exam and review the OCT images before they determine if a repeat Anti-VEGF Injection is necessary.
What Happens During the Procedure?
The Eye Injection Procedure which begins with the patient in a reclined comfortable position. We clean the eyelids and the area around the eye very carefully and also apply an antiseptic to lower the risk of infection. We use a small holder for the eyelid which prevents the eye from blinking during the procedure.
The doctor has the patient look in specific direction, then he injects the medication in the white part of the eye with a fine needle. In the course of an Intravitreal Injection the patient may notice some pressure, a flash of a pinching or a quick little scratch which is fine, but very serious pain does not usually report. Also from MedlinePlus we find that the full appointment will last some 15 to 30 minutes in total, although the injection is very short.
After the Eye Injection Procedure we note that the doctor will check the treated eye and at times the eye pressure. Mostly patients are able to go home right after the procedure, but some may stay a little while longer until they are sure the patient is stable enough to go home.
Is the Injection Painful?
Fear of pain is a common issue before going in for an Anti-VEGF Injection. We use numbing drops which make the treatment more comfortable, also the needle is in for a very brief time. Most patients report pressure or a short sensation which is not at all severe pain.
During the course of the Eye Injection Procedure what we see is you keep the head still, breath normally and follow the instructions regarding which way to look that makes the experience easier. The eyelid holder is used which takes care of eye blinking and also the injection is not given through the center of the cornea or pupil.
Benefits of Anti-VEGF Treatment
The primary benefit of an Anti-VEGF Injection is that it goes after a key cause of abnormal retinal leakage. As per the condition and its severity treatment may reduce macular fluid, stop abnormal vessel growth, prevent further bleed and preserve central vision. The National Eye Institute reports that by which it blocks excessive VEGF activity vision improvement is seen in certain retinal diseases.
An Intravitreal Injection also may be repeated with no need for inpatient care. OCT scans report to the retina specialist on retinal fluid and thickness over time, which in turn allows the doctor to change the treatment schedule based on the eye’s response.
However at present an Anti-VEGF Injection does for retinal disease what we hope it will do which is to control it rather than to completely cure it. MedlinePlus reports that drugs like ranibizumab and aflibercept do a good job of managing some retinal issues but in many cases are not a cure which is why it is important to have ongoing care.
| Expected benefit or limitation | What it may mean for the patient |
| Reduced retinal fluid | Vision may become clearer as swelling decreases |
| Less abnormal vessel activity | Further leakage or bleeding may be limited |
| Protection of central sight | Reading and recognising faces may be better preserved |
| Repeatable treatment | Additional doses can be given when disease activity returns |
| Variable treatment response | Vision may improve, remain stable or continue to worsen |
| Ongoing retinal reviews | OCT scans and examinations guide further treatment |
Side Effects and Possible Risks
In most cases patients do not experience a serious complication from Anti-VEGF Injection. There may be temporary grittiness, watering, a red patch on the white of the eye, mild blurred vision or a few floaters. NHS aftercare info reports that mild tenderness, bloodshot area and temporary floaters will improve over the following days.
An Intravitreal Injection has with it some rare but very important risks which include infection within the eye, inflammation, raised eye pressure, bleeding, retinal tear or detachment, lens injury and significant vision loss. MedlinePlus reports infection, inflammation, bleeding, increased eye pressure and damage to retinal structures as possible complications.
The medicine does in fact require extra care. An active eye infection or high degree of inflammation which may delay treatment. Also if you have had recent cardiac issues, are pregnant or have other large health issues bring in your full health history before we go ahead with the Anti-VEGF Injection.
Eye Injection Recovery
For the large part Eye Injection Recovery is a simple process. Vision may stay blurred for a while due to the use of dilating drops, surface irritation or from small bubbles which have entered the eye. Mild grittiness and watering are very typical, also a surface blood spot may take several days to go away.
During Post Eye Injection Recovery patients should not put pressure on the treated eye. Also avoid swimming in and exposure to possibly contaminated water as per ophthalmologist’s advice. MedlinePlus says to avoid eye rubbing for a few days and to stay out of the pool for at least 3 days
Routine functions may return right away, but to play it safe do not get back in the car until your vision is fully back to normal. At Cambridge University Hospitals we report that for many of our patients normal routine is restored the day after. However Individual Eye Injection Procedure instructions should always take priority.
Warning Signs That Need Urgent Care
Mild symptoms should better and not get worse. What is not normal for Eye Injection Recovery is increasing pain, greater redness, swollen eyelids, light sensitivity, quick decline in vision, a sudden increase in floaters, flashes or a dark curtain over the field of Eye Injection Recovery. NHS guidance says to seek urgent assessment for pain and redness which increases, quick loss of vision, a sudden increase in floaters or a dark curtain which covers your vision.
Patients should not delay until their next scheduled visit if these symptoms present after an Intravitreal Injection. The retina team or ophthalmic emergency room should be immediately contacted.
How Many Injections Are Needed?
One Anti-VEGF Injection dose may not provide long term control. At first many patients present for very close follow up and initial treatment intervals are frequent which the NEI reports to be a common practice. Some patients do require that level of monthly treatment in the beginning, other patients see a lengthening of the time between treatments as the retina stabilizes. We also see that some patients do go onto less frequent injections over time while at the same time some require to stay on a more regular treatment regime to protect vision.
A repeat Anti-VEGF Injection is recommended when OCT shows persistent or returning fluid, bleeding is present, or visual findings point out that disease has flared. The doctor may follow a fixed schedule, as needed, plan or treat and extend the approach. Missing an Intravitreal Injection or retinal review may allow disease to return before the patient notes an obvious visual change.
Supporting Better Treatment Results
The Eye Injection Procedure is a component of our long term retinal care. Report to us any new distortion, central blurring, flashes, floaters or sudden visual changes which may occur between your scheduled visits. We will perform follow up exams to identify if the fluid is returning or if there is abnormal vessel activity.
Patients should attend all review appointments, present with a current medicine list and report any new health issues. We have put together info on what to expect before Anti-VEGF Injection, tips for transport and warning signs which we think will make the process less stressful and support better Eye Injection Recovery.
When to Consult a Retina Specialist
Blurred or wavy central vision, straight lines which appear bent, a dark spot in the center, sudden appearance of new floaters or retinal changes related to diabetes require prompt assessment. A retina specialist will determine if an Anti-VEGF Injection is right for you and how often your eye should be monitored.
At our ASG Eye Hospital we offer to our patients a retinal evaluation, diagnostic imaging and in depth treatment discussion. Our final treatment plan is based in the diagnosis, present vision, OCT results, past treatment response and general medical history.
Frequently Asked Questions
1. Is an anti-VEGF eye injection safe?
An Anti-VEGF Injection does for the most part go well when we take sterile precautions. What we see more of is temporary irritation or a surface blood spot than we do serious complications. Severe pain, increased redness or sudden vision loss require prompt medical care.
2. How long does the treatment take?
The Full Eye Injection Procedure may run between 15 to 30 minutes which includes prep, clean, numbing and final check times. The actual injection itself is only for a few seconds.
3. Can I see the needle?
In most cases the needle is not visualized by the patient. During an Intravitreal Injection which we perform the doctor will ask you to look away from the site of treatment. Also at times there may be a flash of light or a shadow that you see.
4. When can I return to work?
Many patients return to work the next day once their vision is to the usual level and discomfort has lessened. In Eye Injection recovery may take longer if work consists of dust, contaminated water, heavy physical activity or detailed visual tasks.
5. Can I wash my face after treatment?
Gentle cleansing of the face is usually advised but patients should refrain from rubbing the affected eye and also from allowing soap or unclean water in to it. Follow the clinic’s written Eye Injection Recovery instructions.
6. Will one injection be enough?
One dose may not be sufficient. Anti-VEGF injections may be administered several times as part of an ongoing treatment depending on the results of a series of OCT scans.
7. What should I do if I miss an appointment?
Contact the retina specialist right away to rebook. Delay of the Eye Injection Procedure may allow for return of retinal fluid or abnormal blood vessel activity.
8. Where is the medicine placed?
An Intravitreal Injection is performed via the white of the eye into the vitreous cavity which is away from the central cornea and pupil.
9. Which symptoms are expected afterward?
Mild grittiness, watering, temporary blurred vision, a red spot of small size and some floaters may be experienced during Eye Injection Recovery. Increase in pain, redness which gets worse or a change in vision is not typical and requires urgent assessment.
