As retinal specialists, we give hundreds of intraocular injections (injections into the eye) each month. Patients with macular degeneration, diabetes, vein occlusions, and now macular holes receive injections to treat their disease, often monthly.
When we first tell a patient he or she will be receiving an injection into his or her eye, there is always a degree of fear that the patient feels. After all, an injection in the arm hurts bad enough, how much pain does an injection into the eye cause? The answer, more often than not, surprises the patient- not much. In fact, many patients report not even feeling the injection or feeling only a small amount of pressure.
To prepare for the injection, we numb the eye. Then, we use a very small (30 gauge) needle to inject the medication. Between the numbing and the small needle, the procedure is usually over before the patient knows it.
The day of the injection, patients often report mild stinging or burning in the eye. This is due to a combination of the numbing medicine and the betadine, the medicine we use to kill the bacteria in the eye. The stinging is usually gone by the next day.
If the patient continues to have pain the day after or increasing pain and swelling around the eye, we encourage them to call us immediately to discuss this as it could be a sign of an infection.
So, if you are having an intraocular injection, you can rest easy knowing that most patients experience only mild, if any, discomfort, from the process.
This is for informational purposes only and is not intended to be medical advice. Please consult your physician for medical advice.
Showing posts with label intraocular injection. Show all posts
Showing posts with label intraocular injection. Show all posts
Friday, February 8, 2013
Tuesday, October 30, 2012
Antibiotics after intraocular injections
Intravitreal injections for macular degeneration, diabetic macular edema, and other conditions are becoming more and more common. The risk of endophthalmitis, or infection in the eye, is the most concerning ocular risk of these injections. Recently, vitreoretinal surgeons have been changing their minds about antibiotics before, during, and after intravitreal injections and many patients have questions about the sudden change.
When intravitreal injections first began for macular degneration, they were a newer procedure. We had done a few before for various conditions, but never before in the quantity and regularity we are doing them now. For many intraocular procedures such as cataract surgery, glacuoma surgery, or even retinal surgery, post-operative antibiotic drops are recommended. So, we routinely used them after intravitreal injection.
In 2011, an ARVO poster from Bascom Palmer showed that with merely providone-iodide pre and post injection, and no post-operative antibiotic drops, there was no greater risk of post-injection infection (1). An article was then published showing routine use of post-injection antibiotics selects resistant bacteria (2).
Subsequently, in 2012, a large study of 15,895 patients was published that showed infeciton rates by Cheung, et al 5 in 8259 for patients who were given antibiotics for 5 days after injection, 2 in 2370 for those who received antibiotics immediately after each injection, and 2 in 5266 who received no antibiotics. There was no statistically significant difference amongst the groups. Several smaller studies have all confirmed that the risk remains about 1 in 1000 to 1 in 5000 patients that get an infection after intravitreal injection.
In light of all of the data showing no benefit to antibiotic drops after injection, and data suggesting maybe a negative effect of antibiotic drops after injection, many retina specialists have stopped using them post injection.
If you have any signs of infection after your injection such as decreasing vision, increasing eye pain, or redness or swelling of the eye or eyelid, you should contact your eye physician.
This is not intended to be medical advice and is for informational purposes only. Please consult a qualified eye care professional if you have questions or concerns.
1. Rumya R. Rao, Golnaz Javey, Philip J. Rosenfeld, William J. Feue. Elimination of Post-Injection Topical Antibiotics after Intravitreal Injections. ARVO May, 2011
2. Kim SJ, Toma HS. Ophthalmic antibiotics and antimicrobial resistance a randomized, controlled study of patients undergoing intravitreal injections.Ophthalmology. 2011 Jul;118(7):1358-63. Epub 2011 Mar 21.
When intravitreal injections first began for macular degneration, they were a newer procedure. We had done a few before for various conditions, but never before in the quantity and regularity we are doing them now. For many intraocular procedures such as cataract surgery, glacuoma surgery, or even retinal surgery, post-operative antibiotic drops are recommended. So, we routinely used them after intravitreal injection.
In 2011, an ARVO poster from Bascom Palmer showed that with merely providone-iodide pre and post injection, and no post-operative antibiotic drops, there was no greater risk of post-injection infection (1). An article was then published showing routine use of post-injection antibiotics selects resistant bacteria (2).
Subsequently, in 2012, a large study of 15,895 patients was published that showed infeciton rates by Cheung, et al 5 in 8259 for patients who were given antibiotics for 5 days after injection, 2 in 2370 for those who received antibiotics immediately after each injection, and 2 in 5266 who received no antibiotics. There was no statistically significant difference amongst the groups. Several smaller studies have all confirmed that the risk remains about 1 in 1000 to 1 in 5000 patients that get an infection after intravitreal injection.
In light of all of the data showing no benefit to antibiotic drops after injection, and data suggesting maybe a negative effect of antibiotic drops after injection, many retina specialists have stopped using them post injection.
If you have any signs of infection after your injection such as decreasing vision, increasing eye pain, or redness or swelling of the eye or eyelid, you should contact your eye physician.
This is not intended to be medical advice and is for informational purposes only. Please consult a qualified eye care professional if you have questions or concerns.
1. Rumya R. Rao, Golnaz Javey, Philip J. Rosenfeld, William J. Feue. Elimination of Post-Injection Topical Antibiotics after Intravitreal Injections. ARVO May, 2011
2. Kim SJ, Toma HS. Ophthalmic antibiotics and antimicrobial resistance a randomized, controlled study of patients undergoing intravitreal injections.Ophthalmology. 2011 Jul;118(7):1358-63. Epub 2011 Mar 21.
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