![]() The choice of anesthetic depends on physician preference, and is also dictated by how the patient tolerated prior injections. Topical, subconjunctival, or pledgets are commonly used routes of local anesthesia for in-office intravitreal injections. Ganciclovir 4mg/0.1mL - administer 2 mg in 0.05 mL (twice weekly for cytomegalovirus retinitis for 14 days for induction).Triamcinolone acetonide (Kenalog, off-label) 2mg/0.05mL or 4mg/0.1mL (Triesence/ Trivaris is alcohol-free preparation that is FDA-approved for intraocular use).Ranibizumab-eqrn (Cimerli) 0.5 mg/0.05 mL (biosimilar for neovascular AMD, RVO, myopic CNVM) or 0.3 mg/0.05 mL (biosimilar for diabetic retinopathy/DME).Ranibizumab-nuna (Byooviz) 0.5 mg/0.05 mL (biosimilar for neovascular AMD, RVO, myopic CNVM).Ranibizumab (Lucentis) 0.5 mg/0.05 mL (for neovascular AMD, RVO, myopic CNVM) or 0.3 mg/0.05 mL (for diabetic retinopathy/DME).Bevacizumab (Avastin, off-label) 1.25 mg/0.05 mL (0.675 mg/0.03 mL if considering using for treatment of Zone I+ ROP in an infant).In the case of an infection, the benefit is also direct delivery of the antibiotic/antifungal into the eye close to the nidus of the infection.ĪLTERNATIVES to intravitreal injections can include observation, surgery (pars plana vitrectomy), or laser treatment (e.g., laser photocoagulation or photodynamic therapy) depending on the ocular disease. Need for additional injections in future (patients need to understand this)īENEFITS of intravitreal injections depend on the ocular pathology being treated, but typically include improvement in vision or prevention of worsening vision (in the case of AMD, DR, RVO).Off-label use (for bevacizumab, triamcinolone, other medications).Stroke/heart attack (with anti-VEGF medications, controversial).Need for surgery (to address some of the complications above).Increased intraocular pressure with damage to optic nerve (primarily with steroids but may also occur after higher numbers of anti-VEGF injections).Loss of the eye (from a severe infection).Uveitis / retinal vasculitis (higher risk with brolucizumab).Cataract (from inadvertently hitting the lens).Bleeding (subconjunctival, vitreous hemorrhage).Pain / foreign body sensation / epiphora (possibly due to dry eye, corneal abrasion, infection).The RISKS of intravitreal injections include: ![]() Obtain informed consent and have the patient's signature on the consent form witnessed. Informed Consent and Risks of Intravitreal Injectionsĭiscuss the indications, risks, benefits, and alternatives with patients. ![]()
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