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Intravitreal administration
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Intravitreal administration
Intravitreal administration is a route of administration of a drug, or other substance, in which the substance is delivered into the vitreous humor of the eye. "Intravitreal" literally means "inside an eye". Intravitreal injection is the method of administration of drugs into the eye by injection with a fine needle. The medication will be directly applied into the vitreous humor. It is used to treat various eye diseases, such as age-related macular degeneration (AMD), diabetic retinopathy, and infections inside the eye such as endophthalmitis. As compared to topical administration, this method is beneficial for a more localized delivery of medications to the targeted site, as the needle can directly pass through the anatomical eye barrier (e.g. cornea, conjunctiva and lens) and dynamic barrier (e.g. tears and aqueous humor). It could also minimize adverse drug effects on other body tissues via the systemic circulation, which could be a possible risk for intravenous injection of medications. Although there are risks of infections or other complications, with suitable precautions throughout the injection process, chances for these complications could be lowered.
Intravitreal injections were first introduced in 1911 when Ohm gave an injection of air into the vitreous humor to repair a detached retina. In the mid-1940s, intravitreal injections became a standard way to administer drugs to treat endophthalmitis and cytomegalovirus retinitis.
Intravitreal injections were proposed over a century ago, however the number performed remained relatively low until the mid 2000s. Until 2001, intravitreal injections were mainly used to treat end-ophthalmitis. The number of intravitreal injections stayed fairly constant, around 4,500 injections per year in the US. The number of injections tripled to 15,000 in 2002, when triamcinolone injections were first used to treat diabetic macular oedema. This use continued to drive an increase to 83,000 injections in 2004. In 2005, bevacizumab and ranibizumab intravitreal injections for the treatment of wet-AMD caused a rise in injections to 252,000. In 2008, over 1 million intravitreal injections were performed. This doubled to 2 million just 3 years later in 2011 when aflibercept (another anti-VEGF intravitreal injection) became available for the treatment of wet AMD. Intravitreal injections hit an all-time high in 2016, reaching over 5.9 million injections in the US.
Intravitreal injection was first mentioned in a study in 1911, in which the injection of air was used to repair a detached retina. There were also investigations evaluating intravitreal antibiotics injection using sulfanilamide and penicillin to treat endophthalmitis in the 1940s, yet due to the inconsistency of results and safety concerns, this form of drug delivery was only for experimental use and not applied in patients. It was until 1998, that fomivirsen (Vitravene), the first intravitreal administered medication, was approved by the U.S. Food and Drug Administration (FDA).
In 2004, when Aiello et al. published the first guidelines for intravitreal injection in the journal Retina, fomivirsen was still the only medication licensed by the FDA for intravitreal injection. At the end of the year, on December 17, the first intravitreal anti-VEGF drug pegaptanib (Macugen) was also licensed by FDA for treatment of wet age-related macular degeneration (wet AMD).
Intravitreal injection has then become more common and a surge in the number of injections performed could be seen. Six extra medications, namely triamcinolone acetonide, ranibizumab (Lucentis), aflibercept (Eylea/Zaltrap), dexamethasone, ocriplasmin and fluocinolone acetonide were approved for this injection by the end of 2014. There are also increasing off-label use of bevacizumab (Avastin) for the management of various ophthalmologic diseases, like AMD, retinal vein occlusion and diabetic macular edema. On top of that, the number of intravitreal injections has escalated from less than 3000 per year in 1999, to an estimation of near 6 million in 2016.
Intravitreal injection is used to inject a drug into the eye to reduce inflammation (anti-inflammatory), inhibit the growth and development of new blood vessels (angiostatic), or lower the permeability of blood vessels (anti-permeability), in turn curing various eye diseases.
Disorders/diseases that can be treated with intravitreal injection include:
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Intravitreal administration
Intravitreal administration is a route of administration of a drug, or other substance, in which the substance is delivered into the vitreous humor of the eye. "Intravitreal" literally means "inside an eye". Intravitreal injection is the method of administration of drugs into the eye by injection with a fine needle. The medication will be directly applied into the vitreous humor. It is used to treat various eye diseases, such as age-related macular degeneration (AMD), diabetic retinopathy, and infections inside the eye such as endophthalmitis. As compared to topical administration, this method is beneficial for a more localized delivery of medications to the targeted site, as the needle can directly pass through the anatomical eye barrier (e.g. cornea, conjunctiva and lens) and dynamic barrier (e.g. tears and aqueous humor). It could also minimize adverse drug effects on other body tissues via the systemic circulation, which could be a possible risk for intravenous injection of medications. Although there are risks of infections or other complications, with suitable precautions throughout the injection process, chances for these complications could be lowered.
Intravitreal injections were first introduced in 1911 when Ohm gave an injection of air into the vitreous humor to repair a detached retina. In the mid-1940s, intravitreal injections became a standard way to administer drugs to treat endophthalmitis and cytomegalovirus retinitis.
Intravitreal injections were proposed over a century ago, however the number performed remained relatively low until the mid 2000s. Until 2001, intravitreal injections were mainly used to treat end-ophthalmitis. The number of intravitreal injections stayed fairly constant, around 4,500 injections per year in the US. The number of injections tripled to 15,000 in 2002, when triamcinolone injections were first used to treat diabetic macular oedema. This use continued to drive an increase to 83,000 injections in 2004. In 2005, bevacizumab and ranibizumab intravitreal injections for the treatment of wet-AMD caused a rise in injections to 252,000. In 2008, over 1 million intravitreal injections were performed. This doubled to 2 million just 3 years later in 2011 when aflibercept (another anti-VEGF intravitreal injection) became available for the treatment of wet AMD. Intravitreal injections hit an all-time high in 2016, reaching over 5.9 million injections in the US.
Intravitreal injection was first mentioned in a study in 1911, in which the injection of air was used to repair a detached retina. There were also investigations evaluating intravitreal antibiotics injection using sulfanilamide and penicillin to treat endophthalmitis in the 1940s, yet due to the inconsistency of results and safety concerns, this form of drug delivery was only for experimental use and not applied in patients. It was until 1998, that fomivirsen (Vitravene), the first intravitreal administered medication, was approved by the U.S. Food and Drug Administration (FDA).
In 2004, when Aiello et al. published the first guidelines for intravitreal injection in the journal Retina, fomivirsen was still the only medication licensed by the FDA for intravitreal injection. At the end of the year, on December 17, the first intravitreal anti-VEGF drug pegaptanib (Macugen) was also licensed by FDA for treatment of wet age-related macular degeneration (wet AMD).
Intravitreal injection has then become more common and a surge in the number of injections performed could be seen. Six extra medications, namely triamcinolone acetonide, ranibizumab (Lucentis), aflibercept (Eylea/Zaltrap), dexamethasone, ocriplasmin and fluocinolone acetonide were approved for this injection by the end of 2014. There are also increasing off-label use of bevacizumab (Avastin) for the management of various ophthalmologic diseases, like AMD, retinal vein occlusion and diabetic macular edema. On top of that, the number of intravitreal injections has escalated from less than 3000 per year in 1999, to an estimation of near 6 million in 2016.
Intravitreal injection is used to inject a drug into the eye to reduce inflammation (anti-inflammatory), inhibit the growth and development of new blood vessels (angiostatic), or lower the permeability of blood vessels (anti-permeability), in turn curing various eye diseases.
Disorders/diseases that can be treated with intravitreal injection include:
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