What to Expect With Eye Injections for Diabetic Macular Edema

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Caucasian male eye doctor giving Caucasian female patient eye injection

If you have diabetes, you know it’s about more than just having high blood sugar. Diabetes is considered a systemic disease that can affect multiple organs and tissues throughout your body, so it’s important to monitor and treat any associated conditions that develop. For example, diabetic macular edema, an eye disease believed to affect about 10% of Americans with diabetes, can lead to permanent vision loss if it progresses.

However, proper treatment of diabetic macular edema, often with the use of special eye injections, may help protect your vision.

What is diabetic macular edema?

Prolonged high blood sugar from diabetes can weaken the small blood vessels in the retina of your eyes, leading to a condition known as diabetic retinopathy. The damaged vessels can bleed or leak fluid into your macula, an area in the center of your retina, and cause swelling. This is called diabetic macular edema.

Your macula is responsible for helping you see things in detail, as well as providing you with your straight-ahead central vision necessary for driving and reading. But when swelling is present in your macula, your central vision can become blurry or distorted, and your color perception may be affected. You can also develop dark or blind spots in your visual field. Diabetic macular edema is the number one cause of vision loss in those who have diabetic retinopathy.

How are eye injections used to treat diabetic macular edema?

Though it’s most important to address the underlying cause of diabetic macular edema by working to control your blood sugar levels, eye injections also play a significant role when it comes to treatment. There are two main types that are used:

  • Anti-VEGF injections: The diabetic retina produces a protein called vascular endothelial growth factor (VEGF). VEGF plays a role in the growth of new abnormal blood vessels in your retina that leak into your macula. But if you receive an injection that blocks VEGF, this process can be halted, slowing the progression of diabetic macular edema. Three injectable anti-VEGF medications are available: bevacizumab (Avastin), aflibercept (Eylea), and ranibizumab (Lucentis). They are initially injected about once a month but may be spread out at longer intervals over time. Anti-VEGF injections may also be used to treat other eye conditions that result in macular edema, like wet age-related macular degeneration.

  • Steroid injections: Steroids are known for their anti-inflammatory effects and may be given as eye injections to reduce macular swelling. Triamcinolone (Kenalog) injections work quickly, but can wear off after 4 to 6 weeks. Dexamethasone (Orzudex) and fluocinolone (Ileuvien) are injectable implants that slowly release medication over time. They can help decrease swelling for 3 to 4 months and up to 3 years respectively.

Laser treatments are still sometimes used to help seal off the leaking blood vessels in the retina, but eye injections are now preferred as first-line therapy for diabetic macular edema. Your eye doctor will determine which treatment is most appropriate for your case.

What should I expect with eye injections?

It may sound intimidating to get an injection into your eye, especially the first time when you don’t know what to expect. In most cases, though, patients experience little to no discomfort during the procedure. Before the injection is administered, you’ll be given numbing eye drops (or in some cases a small numbing injection). Your eyes will then be cleaned with a special solution to kill any bacteria. The eyelids are held open with an instrument called a speculum to keep you from blinking. Then, using a very small needle, your eye doctor will inject the medication through the outer white portion of your eye. Your eye will be cleaned and examined for any complications after the injection is complete.

It’s normal to experience some mild eye irritation or dryness over the following few days. Your doctor may prescribe antibiotic eye drops for a short period, and artificial tears can help if your eyes feel dry. Serious complications are rare, but if you have significant pain or changes in your vision, be sure to contact your doctor right away.

Keep in mind, not everyone who has diabetes will develop diabetic macular edema. You can minimize your risk by living a healthy lifestyle, sticking to your diabetes treatment plan, and getting regular eye exams to detect any vision problems before serious complications develop.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 22
  1. Diabetic Macular Edema- Personalizing Treatment. American Academy of Ophthalmology. https://www.aao.org/eyenet/article/diabetic-macular-edema-personalizing-treatment
  2. Facts About Macular Edema. National Eye Institute. https://nei.nih.gov/health/macular-edema/fact_sheet
  3. Intravitreal Injections. American Society of Retinal Specialists. https://www.asrs.org/patients/retinal-diseases/33/intravitreal-injections
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