Intravitreal Injections (anti-VEGF)

What are intravitreal anti-VEGF injections

VEGF (vascular endothelial growth factor) normally participates in the development of blood vessels; in certain retinal conditions, its excessive activity is linked to fluid leakage, macular oedema, or neovascularisation that threatens central vision. Anti-VEGF medications target this stimulation and, in suitable indications, help stabilise or improve the picture, without "curing" the underlying disease in all its forms.

The treatment is part of the broader context of retina and macula diseases. Clinical examination is often combined with OCT / OCTA to measure thickness and flow, digital fundus photography to monitor lesions, and, where indicated, fluorescein angiography (FA) for more detailed vascular information. Interpretation is carried out by the ophthalmologist and determines the frequency of injections and treatment goals.

The dry form of age-related macular degeneration and other conditions without active oedema or neovascularisation are not treated in the same way; in selected dry AMD scenarios, other approaches such as Valeda (PBM) treatment may be discussed, always at the doctor's discretion. For acute or advanced conditions with ischaemia or a need for panretinal stabilisation, the plan may also include argon laser photocoagulation, either together with or at a different stage from the injections.

Indications and clinical context

In clinical practice, anti-VEGF injections are used most often for wet (neovascular) age-related macular degeneration, for diabetic macular oedema (DME), and for complications of branch or central retinal vein occlusion where there is oedema or neovascularisation that justifies treatment. The precise diagnosis, stage and presence of coexisting conditions (e.g. diabetes mellitus, hypertension) determine the intensity of monitoring and the schedule.

The goal is not always "perfect" vision but reducing oedema, limiting leakage, and protecting the macula over time. Some patients respond quickly, others need more repetitions or a change of regimen; the decision is based on repeated examination and imaging, not on a fixed "one-size-fits-all" pattern.

Preventive eye examination as part of a comprehensive eye check-up helps ensure diabetic retinopathy or other conditions are identified before irreversible loss occurs, so that injections, when needed, are part of a plan that already understands the underlying disease.

Medications, loading and maintenance plan

Approved medications used include aflibercept (Eylea), faricimab (Vabysmo), ranibizumab (Lucentis) and, in selected cases, brolucizumab (Beovu), always according to indications, tolerance and your treating physician's guidance. The choice and frequency are not identical for every patient; there are phases of more frequent injections (loading) followed by a maintenance interval or restarting when oedema recurs on imaging or in the clinical picture.

The discussion includes realistic expectations, the cost and time of travel, and adherence to monitoring. Stopping without medical guidance may allow oedema to recur; changes to the plan are made after examination, not based only on a subjective sense of improvement.

How the injection is performed

The procedure is carried out in a sterile surgical area, under aseptic conditions. It is preceded by local anaesthesia with eye drops, cleaning and opening of the eyelids with a sterile instrument; the injection is given through a fine needle into the vitreous, in a specific quadrant chosen clinically. The patient is awake; the procedure itself is brief, but preparation and postoperative checks can add time to the visit.

After the injection there may be small floaters, blurring or redness at the site, which usually resolve. Written instructions are given for hygiene, use of drops where prescribed, and when cleaning the eye or strenuous physical activity is permitted. Severe pain, a significant reduction in vision, marked redness with discharge, or a "curtain" sensation require immediate contact according to the emergency instructions.

• A companion or public transport if vision is blurred after the procedure
• Avoid rubbing the eye and follow the drop schedule
• Keep imaging and clinical check appointments even when you "feel fine"

The frequency of visits in the first year is usually higher, then may become less frequent if the picture remains stable. Any recurrence on OCT or new symptoms bring back the need for a more frequent plan.

Risks, combination with laser and referrals

As with any intravitreal procedure, rare but serious complications exist (endophthalmitis, retinal detachment, increased pressure, inflammation, etc.); overall frequency is low when protocols are followed. Injections do not replace control of diabetes or blood pressure; they remain part of broader care.

In selected cases the plan is combined with argon laser photocoagulation (e.g. when guidelines and the clinical picture support it for ischaemia or other indications), without this meaning every patient needs both. The sequence and timing are determined individually.

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