Advice after your nerve block for surgery
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Introduction
Diabetes mellitus can affect the eye resulting in a condition known as diabetic retinopathy. This is the most common cause of blindness among the individuals of working age (20 - 65 years). About 8% of UK partial sighted or blind registrations are due to diabetes. If the disease process affects the central portion of the retina called the macula, the condition is then known as maculopathy.
Numerous protein molecules including growth factors such vascular endothelial growth factor (VEGF) mediate the disease process resulting in leakage of fluid in the retina. Pharmacologic inhibition of vascular endothelial growth factor (VEGF) can arrest the disease process.
The standard treatment for "wet" age-related maculopathy disease (AMD) is intravitreal injections (injections into the eye) of ranibizumab (Lucentis) or aflibercept (Eylea) which is approved by the National Institute of Health & Clinical Excellence (NICE).
As per the guidelines set by the National Institute of Health & Clinical Excellence (NICE) not all patients will be eligible for treatment with these injections. For patients not meeting the eligibility criteria, we are considering treating these eyes with intravitreal bevacizumab (AvastinTM) based on scientific evidence available.
Possible benefits and "off label” status
AvastinTM was not initially developed to treat your eye condition. AvastinTM is approved for the treatment of metastatic colorectal cancer. As a condition of approval, the manufacturer produced a label explaining the indications, risks and benefits. The label explains that AvastinTM works by blocking a substance known as vascular endothelial growth factor (VEGF). Blocking or inhibiting vascular endothelial growth factor (VEGF) helps prevent further growth of the blood vessels that the cancer needs to continue growing.
Once a device or medication is approved by the regulatory authorities, physicians may use it 'off-label' for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using AvastinTM 'off-label' to treat AMD, diabetic retinopathy / maculopathy and other similar conditions since research indicates that VEGF is one of the mediators in the occurrence of abnormal vessels that cause these conditions.
Possible limitations and administration
The goal of treatment is to prevent further loss of vision. Although some patients have regained vision, the medication may not restore vision that has already been lost and may not ultimately prevent further loss of vision caused by the disease.
After the pupil is dilated and the eye is numbed with anaesthesia, the medication is injected into the vitreous or jelly-like substance in the back chamber of the eye. Avastin is administered by an injection into your eye as needed at regular intervals (about every 4 to 6 weeks); your ophthalmologist will tell you how often you will receive the injection, and for how long.
Alternatives
You do not have to receive treatment for your condition, although without treatment, these diseases can lead to further vision loss. Other forms of treatment are available including laser treatment to the macula and / or injection of steroid / other drugs into the vitreous.
Risk when AvastinTM is given to treat patients with eye conditions
Ophthalmologists believe that the risk of these complications for patients with eye conditions is low. Patients receiving AvastinTM for eye conditions are healthier than the cancer patients, and receive a significantly smaller dose, delivered only into the cavity of their eye.
One study of patients who received AvastinTM through intravenous infusion reported only a mild elevation in blood pressure. Another study of patients treated like you with intravitreal AvastinTM did not have these elevations or other serious problems seen in patients with cancer.
However, the benefits and risks of intravitreal AvastinTM for eye conditions are not yet fully known. In addition, whenever a medication is used in a large number of patients, a small number of coincidental life-threatening problems may occur that have no relationship to treatment. For example, patients with diabetes are already at risk of heart attacks and strokes. If one of these patients being treated with Avastin suffers a heart attack or stroke, it may be caused by the diabetes and not the Avastin treatment.
Known risks of intravitreal eye injections
Possible complications and side effects of the procedure and administration of AvastinTM include but are not limited to:
- Retinal detachment.
- Cataract formation (clouding of the lens of the eye).
- Glaucoma (increased pressure in the eye).
- Damage to the retina or cornea (structures of the eye).
- Bleeding.
- Allergic reactions - In a small number of people include a rash, hives, shortness of breath, and rarely death.
- Endophthalmitis (severe inflammation or infection of the internal eye tissues) - You may receive eye drops with instructions on when to use them to reduce the possibility of this occurring. Any of these rare complications may lead to severe, permanent loss of vision.
Your condition may or may not get better or may become worse after injection. Any or all complications may cause decreased vision and / or have a possibility of causing blindness. Additional procedures may be needed to treat these complications. During the follow up visits or phone calls, you will be checked for possible side effects and results will be discussed with you.
Patients receiving an injection of AvastinTM may experience less severe side effects related to the pre-injection preparation procedure (eyelid speculum, anaesthetic drops, dilating drops, antibiotic drops, povidone-iodine drops and the injection of the anaesthetic). These side effects may include eye pain, subconjunctival haemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the cornea, inflammation of the eye and visual disturbances.
After the procedure
You should contact your ophthalmologist if any of the following signs of infection or other complications develop such as pain, blurry or decreased vision, sensitivity to light, redness of the eye (compared to immediately after the injection), or discharge from the eye.
You should attend all your post-injection appointment schedules.
Although the likelihood of serious complications affecting other organs of your body is low, you should immediately contact your GP or visit A&E if you experience abdominal pain, chest pain, severe headache, slurred speech or weakness on one side of the body and you should notify these problems to your ophthalmologist.
Things to avoid after procedure
- No rubbing of your eyes.
- Do not swim, use makeup around the eye or do gardening for 5 days after each injection.
If you have any concerns, please contact the staff in the eye treatment centre on the following numbers:
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From 9am to 5pm Monday to Friday: |
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| From 5pm to 9am and at weekends: | 0300 614 5000 and ask for the eye doctor on call |
Contact us
If you have any queries relating to this information, please contact the Ophthalmology service.
About this information
Service:
Ophthalmology
Reference:
QQ/034
Approval date:
5 August 2024
Review date:
1 July 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.