Anti-VEGF Injections — Patient Guide

Anti-VEGF injections are the single most important advance in retinal medicine in the last 25 years. They are small injections of medicine given into the eye to control leaky and abnormal blood vessels at the retina. Conditions that used to cause irreversible blindness — wet AMD, diabetic macular edema, retinal vein occlusion, PCV — are now controllable, often for many years, with these injections.

What Conditions Are Treated?

• Wet age-related macular degeneration (Wet AMD)
• Diabetic macular edema (DME)
• Proliferative diabetic retinopathy (PDR)
• Retinal vein occlusions (CRVO and BRVO) with macular swelling
• Polypoidal choroidal vasculopathy (PCV)
• Myopic choroidal neovascularisation (myopic CNV)
• Choroidal neovascular membranes from any cause
• Retinopathy of prematurity (ROP) in selected cases
• Neovascular glaucoma as part of combined management

How the Injection Is Given

What happens at your injection visit

• You arrive: vision is checked, eye pressure measured, OCT done if needed.
• Anaesthetic drops are placed in the eye to numb it.
• The eye is cleaned with antiseptic (povidone-iodine) and a sterile drape is applied.
• The injection itself takes 3–5 seconds. Most patients feel a small pressure, not sharp pain.
• You blink, the drape is removed, and the eye is washed.
• You rest briefly; the eye pressure and vision are re-checked.
• You go home the same day. Total visit usually under 60–90 minutes.

The Anti-VEGF Drugs We Use

The choice depends on your condition, response, eye anatomy, and cost. We will discuss the options with you.

How Many Injections Will I Need?

Most diseases follow a “loading then maintenance” pattern:

• Loading phase — typically 3 monthly injections to dry the retina.
• Maintenance phase — based on monthly OCT response, the interval is gradually extended (treat-and-extend) or fixed monthly.
• Year 1 typically needs 5–7 injections in DME and wet AMD.
• Subsequent years usually require fewer injections, sometimes none in some patients.
• Some patients can be tapered off entirely; others need long-term maintenance.

Side Effects and Safety

Common, expected, mild

• Mild redness at the injection site for a day or two
• A small subconjunctival haemorrhage (a red patch on the white of the eye) — harmless
• Brief gritty sensation, mild watering
• Small black floaters from the drug for a few hours after injection

Rare but important

• Infection inside the eye (endophthalmitis) — very rare (around 1 in 2,000–5,000 injections) but a serious emergency. Sudden severe pain, redness or drop in vision in the days after an injection must be reported the same day.
• Retinal detachment or tear — very rare.
• Inflammation inside the eye (mild iritis) — uncommon, treated with drops.
• Rise in eye pressure — usually transient.
• Systemic side effects — the dose used in the eye is very small. Theoretical risks of stroke or cardiovascular events are extremely low.

What to Do After the Injection

• You can read, watch TV, eat normally the same evening.
• Avoid rubbing or pressing the eye.
• Avoid swimming, dusty environments and eye make-up for 2–3 days.
• Use prescribed antibiotic drops if given.
• Small floaters from the drug usually settle within a day.
• If pain or vision worsens, come the same day.

How We Track Your Response

Every visit usually includes OCT — the most sensitive way to see if fluid is going down. We compare your current OCT to your previous scans and decide:

• If the macula is drying nicely, we may extend your next interval (treat-and-extend).
• If fluid persists, we may switch drugs or add steroid, PDT or laser.
• Vision is also tested at each visit, but the OCT often shows changes first.