Invitreal Injections

Papers below explore the use of invitreal injections for macular oedema.  In the UK some of these injections are currently only available on the NHS  for  people with  wet AMD.   However they can be obtained privately and we believe that in some instances, and in exceptional circumstances, hospitals may fund them.   It may require a fight and it may take time which you don’t always have.

Intravitreal Triamcinolone (steroid injection into the eye) for Refractory Cystoid Macular Edema Secondary to Birdshot Retinochoroidopathy. Adam Martidis, MD;
This paper describes the resolution of cystoid macular oedema in two Birdshot patients through steroid injections into the eye. It contains OCT images which will help us understand our own OCT images should we have cystoid macular oedema. The authors point out the risks of these injections into the vitreous (jelly of the eye). The date of the paper, 2001, should be kept in mind. Since then, cyclosporine and/or cellcept has become accepted therapy for Birdshot and the anti vegf injections also can resolve CME. Sometimes an anti vegf injection (lucentis, macugen and avastin) is combined with steroid to enhance effect.

Intravitreal Bevacizumab (AvastinTM) as a potent treatment for refractory macular edema in patients with uveitis. Friederike Mackensen, Matthias D. Becker. 2006.
Five patients with stubborn cystoid macular oedema and inactive uveitis at the time of treatment were given injections of avastin into their eyes. All five patients had a reduction in their macular oedema, four gained at least one additional line in visual acuity while the fifth’s remained the same. The authors note that longer follow up is required to see if the effect is transient or long lasting. More recent studies suggest that the effect is indeed transient in some patients, that repeated injections are required and it is emerging that the effect of repeated injections eventually wears off – It should be noted that lucentis, a similar anti vegf injection into the eye, can be funded for macular degeneration patients in the UK. NHS Trusts will fund the first three injections and, at the moment, 2008, further injections are being funded by the drug company.