INTRAVITREAL INJECTIONS:Intravitreal Injections are increasingly important
for patients with retinal diseases. Many of these treatments are directed at inhibiting
Vascular Endothelial Growth Factor (VEGF). Vascular Endothelial Growth Factor (VEGF)
is a substance made by cells that stimulates the growth and leakage of abnormal
new blood vessels. VEGF plays a large role in the development of wet age-related
macular degeneration (AMD) and other retinal vascular diseases. Multiple new treatments
for wet age related macular degeneration that block VEGF are now clinically available.
These treatments are given as a series of injections into the eye (intravitreal
injection). Intravitreal injections are performed in the office, using an anesthetic
to minimize patient discomfort and antiseptic to minimize the risk of infection.
Patients are able to continue with all normal activities after an injection. In
many cases, repeated injections are necessary to achieve the desired effect.
MACUGEN: Was the first of these agents to become available, gaining FDA approval
in December of 2004. Macugen binds and inactivates a VEGF subtype (VEGF-165) thought
to be most important in disease progression.
AVASTIN: Is an anti-VEGF treatment that is FDA approved for intravenous use
in metastatic colon cancer. Due to its similarity to other anti-VEGF agents used
in macular degeneration and its widespread availability, Avastin has become commonly
used by retina specialists in small doses as an intravitreal injection. Avastin
is used in an off-label (non-FDA approved) fashion for treating wet age related
macular degeneration, diabetic retinopathy, and retinal vein occlusions. Although
mounting evidence has demonstrated the effectiveness and safety of Avastin, further
trials are underway to investigate the use of Avastin inside the eye.
LUCENTIS: Is the newest and most effective anti-VEGF agent approved by the
FDA for the treatment of wet age-related macular degeneration (AMD). In 2 clinical
trials, a majority of patients receiving monthly injections of ranibizumab maintained
their vision. Moreover, approximately one-third of ranibizumab patients had improvements
in vision at 12 months. Lucentis is the first treatment for wet macular degeneration
to show an average improvement in visual acuity after one year of treatment in clinical
Vitrectomy: A sophisticated microsurgical technique in which the vitreous
gel is removed from inside the eye with a small, specialized cutting device, an
operating microscope to look into the eye, and microsurgical instruments. The vitreous
gel is then replaced with a clear saline fluid. Vitrectomy is performed for many
conditions including retinal detachment, diabetic retinopathy, macular pucker or
hole, hemorrhage or infection inside the eye, and ocular trauma. Vitrectomy is usually
performed under local anesthesia.
Scleral Buckle: A special plastic material is placed around the outside to help close
off (or "buckle") retinal tears in patients with a retinal detachment. We also have
specialized equipment that enables us to repair certain retinal detachments in the
office without the need for hospitalization or scleral buckling.