What happens during an Intravitreal Injection?

There are two commonly used drugs for age-related macular degeneration, also known as AMD.

• Aflibercept (Eylea)

• Faricimab (Vabysmo)

These two treatments contain anti-VEGF drugs - this blocks the vascular endothelial growth factor, which stops abnormal blood vessel growth and reduce fluid leakage and swelling.

Vabysmo and Eylea can also be used for other eye conditions such as Diabetic Macular Oedema, Diabetic Retinopathy, and Oedema following a Retinal Vein Occlusion. Eylea may also be used for Myopic Choroidal Neovascularisation.

Other drugs and medications may also be administered directly into the eye, such as dexamethasone.

Eylea, an anti-VEGF drug.

Before the procedure

1. Our staff will prepare the necessary paperwork, which includes explaining the purpose of the procedure, signing off on forms to check your financing coverage and withdraw from your Medisave if you wish to, and obtaining your bank account details for any subsequent refunds due to claim payouts from your insurance.

2. The eye getting the injection will be numbed with eye drops.

3. You will be asked to lie supine on a bed and put on a hair net. Our staff will place items surrounding your face and neck area to create a space for the procedure.

During the procedure

1. The surgeon will further numb the area for injection, and subsequently clean the eye and surrounding areas using iodine as a disinfectant. This may cause some stinging.

2. A device is used to hold the eyelids open, and a measuring instrument is used to mark the site where the injection is to take place - on the white part of the eye ball.

3. The injection is done quickly, often within a few seconds. It is important to keep still and look in the direction as per the surgeon's instructions when the injection is being done.

4. When making the measurement and during the injection, you may feel pressure or very mild pain - for just a few moments. This is normal.

5. The eye is then flushed with saline to rinse out the iodine, and the device used to hold the eyelids open is removed.

Recovery from the procedure

1. Our clinical staff will assist in cleaning up the iodine and instilling lubricating eye drops if you have those - we highly recommend this as it can help reduce the discomfort. It is available for purchase in our clinic.

2. Antibiotics eyedrops is then given, before you leave the procedure room.

3. In some instances, small blood vessels on the surface of the eye ball may be broken during the procedure, causing a bleed to happen on the surface tissue of the eye - called a subconjunctival haemorrhage. This, while looking scary due to the colour of blood, is painless, and will eventually turn brownish, yellowish, and fade away, over the course of the next few weeks.

Things to take note:

• Your vision may be slightly blurry or distorted (e.g. feeling of bubbles, oil, or patches) due to the injected liquid drug inside the eye. This will get better gradually, usually significantly over the next few hours as the medication spreads through the eye, although you may still see it for the next couple of days. The eye will slowly 'absorb' the medication over the next several weeks.

• Your eyes may feel more dry than usual for the next few hours, and this can be gradually resolved with the use of lubricating eye drops (ideally preservative-free).

• Remember to use the antibiotic eyedrops, which will reduce the possibility of having an infection - in general, it is used 4 times a day for the duration of one week. It is to be instilled only in the injected eye (unless there is a reason to use it in the other eye).

• Avoid swimming or going into open water for at least two weeks, and avoid getting soap or shampoo into the eye especially in the first few days from the procedure.

• Wearing dark-coloured clothing and not wearing any jewelry on your head, neck, and face area would be ideal as the iodine used for disinfection may go onto them and cause discolouration. You may consider bringing a pair of sunglasses to help with glare.

What's an emergency?

• Severe or increasing eye pain

• Persistent vomiting

• Vision that suddenly gets much worse

• Flashes of light

• Increasing redness

• Sensitivity to light

• Pus or discharge

Any concerns? Let us know!

We answer your questions!

Note on the use of iodine before eye injections

Iodine is used as an aseptic agent to inhibit microorganisms that can cause serious eye infections. This can cause moderate irritation when it is instilled on the eye. Towards the end of the procedure, the eye is washed to flush out remaining iodine, and the surrounding areas are also cleaned to remove as much iodine as possible. The use of lubricating eye drops can help with comfort in the subsequent few hours. Read more...