Intravirtreal Injections (the Hazards and Complications)

No doubt the procedure of intravitreal injections has anchored itself as one of the most commonly used practices in outpatient clinics of ophthalmology thanks to its easiness, extreme safety and superior results over other techniques as laser photocoagulation.

But since there is nothing devoid of flaws, we will highlight the most common complications after intravitreal procedures and how to minimize their incidence.

Complications of intravitreal injections can be classified it to 3 categories:

A. Complications related to the technique used for preparing patients before undergoing intravitreal injection:

1. The use of lidocaine jelly as a topical anesthetic may act as physical barrier to the action of topical antimicrobial drugs, so the topical antimicrobial drug should be instilled in the eye and allowed to act for at least 30 seconds before using the lidocaine jelly.

2. Subconjuctival injection of lidocaine is another technique used to provide topical anaethesia. It should be avoided because it is somewhat painful to create a subconjunctival bleb full of lidocaine, and can lead to subconjunctival hemorrhage.

3. Prolonged exposure of the eye with the speculum in place and the corneal surface exposed to corneo-toxic drugs as lidocaine can lead to post injection pain, redness of the eye and tearing. This can be minimized by decreasing the time interval between the patient preparation and the process of intravitreal injection.

B. Complications related to the procedure of intravitreal injection itself:

1. Endophthalmitis; the ophthalmologists' nightmare, it has been reported to occur at a rate of 0.1% (1 for every 1000 procedures) which is equal to the rate of endophthalmitis following phacoemulsification surgery.

2. Vitreous hemorrhage.

3. Retinal tears.

4. Retinal detachment.

C. Complications related to the injected drugs:

1. Triamcinolone: the most common are secondary elevated intraocular pressure (ocular hypertension) that may progress to secondary steroid induced open angle glaucoma and increased incidence of developing traumatic cataract.

2. Bevacizumab: the most common with this drug include; infectious endophthalmitis, retinal detachment, traumatic cataract, painless vitreous clouding.

To sum up we can conclude that the procedure of intravitreal injection of drugs for treating various ophthalmic conditions does have complications as there isn't yet a medication or a therapeutic modality that has zero incidence of complications, The rarity of incidence of these complications in addition to the easiness of this technique, it's superior results compared to other therapeutic modalities and the well tolerance of the injected drugs as shown from the various studies made on this issue, all these combined demonstrate why not only intravitreal injection is considered an extremely safe procedure but also why it is becoming one of the mainstay outpatient procedures.

If you have any question regarding the eye Click here.