intravitreal

The vitreous eye

Section through the human eye with macula (yellow spot)

The term intravitreal (abbreviation from Latin intra = inside, inside, and vitrum = glass or vitreous = glass body ) means " into the vitreous body ." This means the direct administration of a drug or a liquid or suspension into the vitreous body Eye . It is a form of parenteral drug delivery. In practice, this is done through an injection .

application

Drug treatment of the retina is difficult. Active substances taken orally, for example in tablet form, but also intravenously administered ( systemic administration) are only transported in traces from the body to the inside of the eye. Increasing the dose so that sufficient medication reaches the eye would be associated with considerable side effects for the rest of the body - in places where the active ingredient is not needed. Therefore, in some cases it makes sense to inject medication directly into the vitreous humor inside the eye in order to achieve targeted treatment with few side effects for the entire body.

Application examples

Intravitreal injection is often used to treat age-related macular degeneration (AMD). Antibodies or antibody fragments are injected into the vitreous . Pegaptanib (an aptamer ), ranibizumab or bevacizumab (both antibodies) can be administered intravitreally by ophthalmologists (eye specialists). Intravitreal injection, for example of cidofovir , can
also be used for cytomegalovirus retinitis (CMVR), a common, vision-threatening , ophthalmic disease that is difficult to treat in the disease complex of acquired immunodeficiency syndrome ( AIDS ) . The treatment of recurrences of the oculocerebral non-Hodgkin lymphoma (NHL) can be done with intravitreal chemotherapy, for example with methotrexate and dexamethasone . In various intraocular inflammatory diseases (inflammation in the eye), the administration of cortisone can be carried out by intravitreal injection. The macular edema that occurs in various diseases (accumulation of fluid at the point of sharpest vision) can be treated with an intravitreal implant of dexamethasone, which is bound to a slowly self-dissolving matrix.

The intravitreal injection for administering medication has been part of the list of benefits of the statutory health insurance in Germany since October 1, 2014 .

Operational approach

The recommendation of the joint macular commission of the Professional Association of Ophthalmologists Germany e. V. (BVA) and German Ophthalmological Society (DOG) for intravitreal injections:

Hands disinfection

sterile gloves, sterile lid speculum , sterile drape

Rinse the eyes with povidone iodide 10%, including the cilia

sterile syringe and cannula

Entering with 3.5 mm limbal distance , step by step with moving the conjunctiva

Possibility of sterile paracentesis if necessary

Indirect ophthalmoscopy

Intraocular pressure control

Educate the patient about endophthalmitis symptoms

Need to be checked after 1–3 days

further controls depending on the product injected

Risks

The technical information lists the most common side effects , conjunctival bleeding, eye pain, the appearance of "floaters" in the field of vision, increased intraocular pressure and inflammation of the eyeball . The most serious complications, which are also associated with the injection in combination, are a endophthalmitis , retinal tears and -ablösungen and traumatic cataracts .