Intravitreal injection treatment (IVT)
Intravitreal injection treatment, also known as IVT, is a treatment method whereby various medications are injected into the inner eye (vitreous humour), mostly on an out-patient basis under operative conditions. It is one of the most modern treatment methods for retinal, macular and vitreous diseases. The DOmed Eye Centre doctors recommend IVT for acute situations requiring treatment in patients with the following conditions:
Treatment process for an IVT
After a local anaesthetic, the medication is injected approximately 6mm into the vitreous humour using a very fine syringe. Alongside simple administration of medication, an implant can be placed into the eye, which evenly delivers the active ingredient over a longer period of time. This reduces the number of procedures required, particularly for chronically ill patients. The particular advantage of an IVT is a drastic reduction of possible side-effects, as it is a localised application requiring a dosage of the active ingredient which is as low as possible.
VEGF blockers to treat AMD and diabetic retinopathy
For a long time, exudative age-related macular degeneration was responsible for half of all losses of sight. The introduction of treatment with medication injections into the vitreous humour have significantly improved prospects for those affected: So-called VEGF blockers block the Vascular Endothelial Growth Factor (VEGF), stopping the vascular growth (angiogenesis).
This makes it possible to stop the deterioration of vision for most patients with late age-related macular degeneration and to improve quality of vision for approximately 50% of patients. However, this method does not make it possible to restore the regions of the retina which have been destroyed.
The following medications may be used for treatment:
Since February 2007, Ranibizumab, a medication derived from Avastin® (Bevacizumab) (see below), has been approved specially for use in eyes. This medication is sold under the brand name of Lucentis® and has been developed specially for the treatment of the eye. Lucentis® is approved for the treatment of exudative AMD, diabetic macular oedemas, macular oedemas in patients with BRVO and CRVO, choroidal neovascularisation in patients with severe myopia and choroidal neovascularisation in connection with rare diseases.
A new medication has been approved in Germany for use in the eyes of adult patients since November 2012. Just like Lucentis®, this medication has been specially developed for use in the eye and has the brand name Eylea ® (Aflibercept). The mode of action of aflibercept is the same as that of ranibizumab (Lucentis®), which was approved in 2007. Eylea® is approved for the treatment of adults with exudative AMD, diabetic macular oedemas, choroidal neovascularisation in patients with severe myopia and macular oedemas in patients with BRVO and CRVO.
This medication related to Lucentis® (ranibizumab) has been being used frequently and with positive treatment results in Germany since 2005 and in the rest of the world to treat exudative AMD. Avastin® (bevacizumab) was originally developed for the treatment of tumours (where new blood vessels also grow) and is approved for the treatment of various tumour diseases under the name of Avastin® (bevacizumab). The use of Avastin® (bevacizumab) is a so-called “off-label use”, which means a use of the medication in an area of application which is not approved by pharmaceutical law. However, this does not mean that doctors are not permitted to use the medication for eyes.
- Ozurdex® (Dexamethasone implant)
Ozurdex® is a drug carrier which is placed inside the eye and then delivers the active ingredient of dexamethasone, a corticoid, over a longer period of time (4-6 months). The medication Ozurdex® (Dexamethasone implant) has been specially approved in Germany since 2010 for use in the eye for the treatment of macular oedemas in patients with retinal vein occlusions, diabetic macular oedemas and since 2011 for the treatment of macular oedemas in patients with uveitis intermedia/posterior.
- ILUVIEN 190 microgram (intravitreal corticosteroid implant)
Iluvien is a “second-line” therapy indicated for the treatment of visual disturbances in combination with chronic diabetic macular oedemas which do not respond sufficiently to the available treatments.