I. What diseases can be treated by intraocular injection of Avastin: Avastin belongs to a kind of anti neovascular drug, which can stop the growth of new blood vessels, reduce the bleeding and exudation of abnormal blood vessels, reduce edema, and thus stabilize or improve vision. At present, it is mainly used for: 1. macular edema caused by various reasons (including diabetic macular edema, macular edema after cataract surgery, macular edema caused by choroiditis or intraocular tumors, etc.); 2. choroidal neovascularization caused by various reasons (including age-related macular degeneration, high myopia, idiopathic choroidal neovascularization, vascular-like streaks, choroidal tumors or neovascularization secondary to inflammation, etc.); 3. Retinal neovascularization (such as diabetic retinopathy, retinopathy of prematurity, retinal vein obstruction, retinal vasculitis, Coats’ disease, etc.); 4. Neovascular glaucoma. Second, what are the advantages of Avastin compared with other anti neovascularization drugs used for intraocular injection? Ranibizumab (Lucentis) is also an anti neovascular drug with basically the same treatment mechanism as Avastin. The results of the CATT study published in April 2011 in the prestigious New England Journal of Medicine showed that Lucentis and Avastin have similar efficacy in the treatment of age-related macular degeneration. In the United States, Lucentis was officially launched in 2006 for the treatment of age-related macular degeneration, while Avastin, although widely used by ophthalmologists, has not been officially approved for the treatment of the eye disease. In China, Lucentis (Noxodes) has been officially marketed in 2012, and the cost of each treatment is estimated to be around 11,000 RMB, while Avastin currently costs around 1500 RMB per treatment. Since both drugs are maintained in the eye for about 4-6 weeks, treatment needs to be repeated every 4-6 weeks until the lesion is scarred. The huge difference in price between the two is the main reason for the current popularity of Avastin. Third, what are the side effects and complications of intraocular injections? The biggest risk of intraocular injections is intraocular infection. Although the chance of this problem is very low, once infection occurs, it is more difficult to control with medication and surgery, and there is a risk of blindness. In addition, injections are generally not recommended for pregnant women. Sometimes after opening the gauze the day after the injection, you may find flakes of bright red bleeding on the white of the eye. This may be caused by capillary dilation caused by the disinfectant before the injection and rupture during the injection, or it may be related to the patient’s high nervousness and elevated blood pressure during the injection. This situation does not require special treatment, just observe for a few days, the bleeding will be absorbed on its own and will not affect your vision recovery. Fourth, what preparations do patients need to make before injection? First of all, let the doctor conduct a comprehensive examination on you and communicate fully with him/her to see if you have got the answers to the following questions: 1. If it is age-related macular degeneration which type does it belong to? If there is edema, what is the height of the edema? 2. Do you need intraocular injection treatment? What is the possibility of improving vision after treatment? 3.What kind of medication is injected? What is the approximate cost of one treatment? Can I be reimbursed? There are various drugs used for intraocular injection, such as Avastin (Bevacizumab), Ranibizumab (Lucentis), VEGF-Trap, KH902, Triamcinolone acetonide (TA), etc. 4.What are the possible complications of the injected drugs? 5.Do I need combined photodynamic therapy (PDT)? 6.How do I make an appointment for the procedure? Secondly, you have to start the antibiotic eye drops 3 days before the injection. If you cannot take the eye drops 3 days in advance, you have to order the eye drops intensively on the day of the surgery, for example, 1 time in 5 minutes, 5~10 times in total. The nurse will flush your tear ducts on the day of the injection. If you have conjunctivitis or tear duct inflammation, the procedure may be delayed. It is best to have someone with you on the day to help you with the registration, payment and signing procedures. It is generally not recommended to inject both eyes at the same time. V. What are the precautions for patients during the operation: Once you enter the operating room, please keep quiet. Too much talking may affect the concentration of the medical staff and is not conducive to keeping the air in the operating room clean. The nurse will first give you a number of anesthetic eye drops. Please keep in mind the eye that needs to be treated and check with the nurse. Once you are on the operating table, please try to stay relaxed, do not tilt your head too much or lower it, and keep your face parallel to the floor. When performing eye disinfection, some patients who are sensitive to the disinfectant solution may experience a stinging pain in the eye, which usually lasts for a short time and is easily tolerated. Some disinfectant may run down the corners of your eyes. Please do not wipe them yourself, as this may touch the disinfected area of your eyes and cause eye infections. After disinfection, your face will be covered with a sterile surgical sheet and you may feel suffocated. When injecting, follow the doctor’s instructions to look in the appropriate place, do not wander around to avoid accidental damage to your eyes from the needle. The procedure is very quick, plus the time of anesthesia is only a few minutes, the patient basically will not have uncomfortable feelings. What are the precautions for patients after surgery: The following may occur after surgery, please do not be nervous: 1, there are small bubble-like floating objects in the eye: this may be a small bubble in the drug floating in the vitreous body, usually the same day can disappear, will not affect your vision; 2, there is blood on the gauze: injection disinfectant caused by eye congestion, the needle is easy to touch the capillaries caused by bleeding, although it looks very red and terrible, but in fact, your vision has no effect. But in fact, it has no effect on your vision, and is generally absorbed in about 10 days; 3, the eyes are very painful after surgery, and there are a lot of tears, like something in the eyes: it may be the effect of disinfectant stimulation, if the pain is really unbearable, you need to come to the hospital to see; if it is still bearable, it can generally be relieved the next day. Do not open the gauze on the day of surgery, you need to come to the hospital for examination on the first day after surgery, and order antibiotic eye drops for 1~2 weeks continuously, at least 4 times a day, and consult your doctor when you need further review after that. In general, you can resume your normal life or work on the second day after surgery. However, you should pay attention to eye hygiene and avoid getting dirty water into your eyes when washing and bathing. Reading and watching TV will not directly affect the recovery of vision, but be careful not to strain too much. However, if you have obvious eye pain, obvious blurred vision, red and congested eyes, you should immediately go to the local hospital ophthalmology department, mainly to understand the occurrence of any infection, never delay!!! 7. How many times do I need to repeat the injection in general? How long is the interval? The number of injections varies from person to person and there is no fixed norm to follow. In general, the number of treatments for idiopathic choroidal neovascularization (medium infiltration) will be less and may require 1-3 times. Macular edema in macular degeneration, venous obstruction, and diabetic retinopathy generally requires multiple treatments. Overseas, 1 injection per month is used, and more than 20 injections are required. Many of our patients have more than 10 injections, mainly depending on OCT and fundus imaging results to see if there are still uncontrolled leaks. The interval between each injection is mostly 4 to 6 weeks. If the lesion is stable, re-injection will be considered if the lesion is enlarged or the leakage is increased according to the OCT and fundus imaging results every month. VIII. Which is better, intraocular Avastin injection or photodynamic therapy (PDT)? Photodynamic therapy has been used in China for 7-8 years, it can make the neovascularization closed and stabilize the vision. Another great benefit is that there are basically no side effects or complications, the downside is that it is more expensive, about 17,000 RMB to do once. The biggest advantage of intraocular Avastin injections is that they are quite cheap and very effective, but the risks are much greater, the most dangerous being infection. Some doctors recommend “combination therapy”, that is, PDT combined with intraocular injections, which may be able to reduce the number of PDT or intraocular injections, reduce the cost, reduce the burden of multiple trips to the hospital for families, and most importantly, reduce the risk of side effects and intraocular injections. 9. I have already had several injections, how come my vision still hasn’t improved? The macula is the most important part of our eye vision, once the macula is diseased, the effect on vision is very serious. Sometimes, because of the long time, the nerve cells have irreversible damage, although there is no more bleeding and edema, but the scar left is right in the center of the macula, so the vision will not be as good as if there is no disease, and there may be visual distortion. Moreover, the current treatment is still treating the symptoms, and the duration of drug maintenance in the eye is limited, so there is a possibility of recurrence. The degree of vision improvement is closely related to the location and size of the lesion, the amount of bleeding, whether there is scarring, whether there is atrophy, whether there is poor blood pressure and blood sugar control, etc. It is also difficult for doctors to accurately predict the degree of vision recovery.