IVOM is an injection in which a medicine is administered directly into the vitreous humour of the eye. It is used to treat certain conditions affecting the retina and the macula. The surface of the eye is numbed locally during the procedure.
Depending on the condition, the treatment may slow down its progression or improve vision. IVOM is usually carried out on an outpatient basis.
What is IVOM?
IVOM stands for intravitreal surgical drug administration. ‘Intravitreal’ means that the medication is administered into the vitreous cavity. This allows the active ingredient to reach the area near the retina.
The macula is the area of the retina responsible for the sharpest vision. It is not punctured by the cannula. The medication is injected into the vitreous humour of the eye and from there reaches the intended treatment site.
VEGF inhibitors are used for a number of different conditions. Depending on the condition, IVOM therapy may also be carried out using a different active ingredient.
For which conditions is IVOM a suitable treatment option?
IVOM is suitable for certain retinal conditions and non-infectious inflammation of the posterior segment of the eye. The underlying condition and the affected area of the retina are decisive factors.
- Wet AMD: In wet age-related macular degeneration, VEGF inhibitors can slow the progression of the condition.
- Diabetic macular oedema: This swelling can result from diabetic retinopathy. IVOM with VEGF inhibitors can improve vision and prevent further vision loss.
- Central retinal vein occlusion: Following the occlusion of a blood vessel in the retina, macular oedema can be treated with intravitreal VEGF inhibitors.
- Uveitis: Intravitreal injection of VEGF inhibitors may also be considered for certain non-infectious inflammations, including intermediate and posterior uveitis.
In the case of diabetic macular oedema, treatment depends on whether the centre of the retina is affected. If the centre of the retina is not involved, IVOM should not be offered. If vision is at risk, focal laser treatment may be considered instead.
IVOM can slow down wet age-related macular degeneration, but cannot cure it. In diabetic macular oedema, it can reduce swelling and help prevent further deterioration of vision.
What is important to bear in mind before the injection?
Before IVOM, you should inform your ophthalmologist of any medication you take regularly. This applies in particular to medicines that inhibit blood clotting.
You should not stop taking blood-thinning medication on your own initiative before an intravitreal injection. An observational study suggests that existing treatment should be continued. Any changes should only be made in consultation with your doctor.
Immediately before the procedure, the surface of the eye is numbed locally with anaesthetic eye drops. The injection is administered under antiseptic and sterile conditions. Antibiotic eye drops or ointments are not routinely required if the procedure is carried out correctly.
How is IVOM carried out?
IVOM is normally an outpatient procedure. A hospital stay may be necessary in individual cases where medically justified.
- The eye and the surrounding area are prepared using antiseptics; the rest of the procedure is carried out under sterile conditions.
- The doctor inserts a cannula into the vitreous cavity.
Local anaesthesia does not make the injection pain-free for all patients. In a clinical trial, the pain was predominantly described as mild. With successive injections, the reported intensity of pain decreased.
In a survey, around 64 per cent of participants found intravitreal treatment less distressing than they had previously expected. This reflects the personal experience of the respondents and is no guarantee of treatment success.
In the case of wet AMD, IVOM treatment with the VEGF inhibitors described begins with one injection per month for the first three months. Thereafter, further injections may be administered monthly or at intervals of two or three months, depending on the medication and the course of the disease.
What are the possible risks and side effects?
A serious infection inside the eye is a possible complication. Under the hygiene conditions described, it occurred in approximately 0.03 per cent of injections, according to patient information from the professional associations.
Milder symptoms were also documented in an observational study of a specific ranibizumab follow-on product. The results cannot be generalised to every active substance and every IVOM.
- Subconjunctival haemorrhage: This side effect was documented following injections with the product under investigation.
- Blurred vision: This visual disturbance was temporary in the observational study.
- Mild eye pain: This also occurred following injection of the active substance under investigation.
What should I look out for after an IVOM?
A prompt follow-up examination by an ophthalmologist is scheduled after IVOM. The recommendation from ophthalmological professional bodies specifies the first to fourth day following the intravitreal injection.
Antibiotic eye drops or ointments are not routinely necessary after the procedure. This applies provided the IVOM was carried out using antiseptic measures and under sterile conditions.
What alternatives are there to IVOM?
In the case of diabetic macular oedema, the choice between IVOM and laser therapy depends primarily on whether the centre of the retina is affected. For laser treatment, the leaks must also be easily accessible.
| Procedure | Who is it suitable for? | Treatment requirements | Advantages and disadvantages |
|---|---|---|---|
| IVOM with VEGF inhibitors | Diabetic macular oedema affecting the centre of the retina | Repeated injections may be necessary. | The treatment can reduce swelling, improve vision and prevent further vision loss. |
| IVOM with a steroid or another VEGF inhibitor | If repeated injections are not sufficiently effective | The active ingredient is changed as part of the injection treatment. Steroid implants require fewer IVOMs than VEGF inhibitors. | With steroids, increased intraocular pressure and lens opacity may occur. |
| Focal laser treatment | Easily accessible leaks or macular oedema without involvement of the central retina where vision is at risk | The affected areas are treated specifically using retinal laser coagulation. | If the centre of the retina is involved, the benefit is less than with IVOM using VEGF inhibitors. |
When does the health insurance cover IVOM?
For the eye conditions listed in the quality assurance agreement, intravitreal treatment forms part of statutory healthcare provision, provided the specified criteria are met. The specific condition and the findings of the eye examination are decisive.
The ophthalmologist performing the procedure requires authorisation from the Association of Statutory Health Insurance Physicians for IVOM to be covered by statutory health insurance. You can enquire about this authorisation during your initial consultation.
Which doctors carry out IVOM?
To carry out an IVOM as part of the statutory health insurance scheme, the doctor must be a specialist in ophthalmology.
Authorisation from the Association of Statutory Health Insurance Physicians is a key requirement for billing under the statutory health insurance scheme. Antiseptic preparation and treatment under sterile conditions are essential for the safe performance of the procedure. During the initial consultation, you can ask the following questions:
- Has approval been granted by the Association of Statutory Health Insurance Physicians for the IVOM procedure?
- Which active ingredient is intended for my condition?
- How many injections are initially planned?
- When will the post-procedure check-up take place?
You will find specialists in IVOM at the end of this text.
Frequently asked questions about IVOM
Is IVOM painful?
IVOM can be slightly painful despite the use of a local anaesthetic. In a clinical trial, participants predominantly described the pain as mild; however, the procedure was not pain-free for everyone.
Do I need to stop taking blood-thinning medication before the treatment?
No, you should not stop taking blood-thinning medication without consulting your doctor. Your current treatment can usually be continued whilst undergoing an intravitreal injection.
Does an IVOM cure wet AMD?
No, an IVOM with VEGF inhibitors does not cure wet AMD. It can slow down the progression of the disease.
How often is an IVOM repeated for wet AMD?
Initially, with the VEGF inhibitors described, one injection is given each month for the first three months. After that, the intervals depend on the medication and the course of the disease; they may be one, two or three months.
What side effects can occur following an eye injection?
Possible side effects include bleeding under the conjunctiva, temporary blurred vision and mild eye pain. Serious potential complications include an infection inside the eye.
Who is authorised to perform an IVOM?
To carry out the procedure under the statutory health insurance scheme, the doctor must be a specialist in ophthalmology. If the treatment is to be billed through the statutory health insurance scheme, the doctor must also obtain authorisation from the Association of Statutory Health Insurance Physicians.
